New York Health Access - Recent Articles

Recent Articles

	Medigap (Medicare Supplemental) Policies and Rates in New York State - with Rate Tables for the Current Year Medigap (aka Medicare supplemental insurance) policies are sold by private health insurance companies to cover some of the "gaps" in expenses not covered under original Medicare. Different Medigap policies in New York State and their Cost. Under federal law, all Medigap plans have standard...


	Medicaid 1915(c) Home-and-Community-Based Services (HCBS) Waiver Programs in New York State Jan. 26, 2026 ALERT: The NHTD HCBS Waiver enrollment cap has been reached, so the waiver is now full. The DOH NHTD waiver website states "Because we have reached the approved maximum number of participants, we cannot process any additional referrals to the Nursing Home Transition and Diversion...


	Medicaid Fair Hearings in NYS - Common Links and Changes Medicaid recipients have the right to request a Fair Hearing to appeal an adverse action. This includes decisions made by a managed care or Managed Long Term Care plan, by the local Dept. of Social Services, or by NYS's contractor, NY Medicaid Choice or the NY Independent Assessor. This is not...


	CDPAP: April 2025 Transition to PPL as Single Fiscal Intermediary - Background, Press & Archive Background. The 2024-25 NYS Budget required all 280,000 Medicaid recipients who have CDPAP services to switch their "Fiscal Intermediary" (FI") the agency that manages payroll and benefits for their Personal Assistants ("PA") to a new "single FI" called Public Partnerships LLC or "PPL." FI's have...


	Medicaid Renewals/Recertifications in NYC- Medicaid can be DISCONTINUED if RENEWAL not returned - Starting April 2025 This article is for people whose Medicaid is administered by the NYC Human Resources Administration (HRA). If your Medicaid is handled by the New York State of Health, your renewal is not covered in this article. For those living in different counties outside NYC, whose Medicaid is administered by...


	Temporary Protected Status (TPS) and Public Health Insurance THE TRUMP ADMINISTRATION HAS ended Temporary Protected Status (TPS) for many countries, but there are some court injunctions extending TPS. See the USCIS website to see updates for particular countries and some information below. What is Temporary Protected Status? TPS is a temporary...


	2025 Medicaid Modernization in New York State: Medicaid Eligibility and Client Management System (MECM) For a background document comparing MAGI Medicaid, Non-MAGI Medicaid, and the Medicare Savings Program, click here. For an example MECM notice showing Medicaid and MSP eligibility, click here. For an example MECM notice showing Medicaid and MSP ineligibility, click here. For a copy of the slides...


	Medicaid Alerts & Other Protocols published by the NYC HRA Medicaid Program HRA Medicaid Alerts are periodic announcements of policy, staff and office changes published by the HRA Medicaid Progarm (MAP) (formerly called the "Medical Insurance and Community Services Administration (MICSA)". The Medicaid Program is the part of New York City’s Human Resource...


	Managed Long Term Care State Complaint Unit for MLTC Problems - 1-866-712-7197 e-mail address after Nov. 1, 2025 MLTCComplaints@health.ny.gov Enrollment complaints - call NY Medicaid Choice - 1-855-886-0570 (Advocates line) or 1-888-401-6582 (Consumers line) Report problems with NY...


	Spousal Impoverishment Protections for Married Couples - If One Spouse is in MLTC, Waiver or Immediate Need - Can use Pooled Trust In this Article KNOW YOUR RIGHTS: Download Consumer Fact Sheet on Tips for Keeping More Income, including Spousal Impoverishment Protections.: What are Spousal Impoverishment Rules? Which Married couples can Use Spousal Impoverishment Protections? Spousal Impoverishment...


	Medicaid Advantage Plus "MAP" - Integrated "FIDE" Appeals & Hearing Process Being Phased Out - Jan. 1, 2026 2025 UPDATE - The integrated appeal and fair hearing process launched for in 2020 for members of Medicaid Advantage Plus (“MAP”) plans is being phased out to end December 31, 2025. See the DOH MAP Integrated Hearings Phase-out plan here. As of January 1, 2026, MAP plans will mostly...


	2026 UPDATE: Elimination of Requirement to Apply for Social Security and Maximize Other Benefits for Medicaid & MSP As of December 23, 2025, Medicaid and Medicare Savings Program (MSP) applicants and recipients are no longer required to pursue potentially available income, including Social Security and IRA distributions, as a condition of receiving Medicaid and MSP. This is from an amendment to federal Medicaid...


	The Minimum ADL Test to Qualify for MLTC, CDPAP or Personal Care - Starting Sept. 1, 2025 Starting September 1, 2025, ADULT Medicaid recipients age 21 and over who are newly applying for Personal care services ["PCS"], Consumer-Directed Personal Assistance (CDPAP), or Managed Long Term Care (MLTC) or Medicaid Advantage Plus (MAP) enrollment must meet a higher eligibility test to...


	Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes start Nov. 1, 2024 Enrollment in a Medicaid Managed Long Term Care (MLTC) plan is mandatory for most adult Dual Eligibles (people who have Medicare or Medicaid), who need Medicaid personal care (PCS) or Consumer Directed Personal Assistance Program (CDPAP) services, with some exceptions - See also DOH list of...


	The Various Types of Medicaid Home Care in New York State New York State has a range of Medicaid home care service programs, each oriented toward slightly different needs and sometimes to different populations. These programs are listed below, with links to detailed information posted on this site. Beginning in September 2012, for ADULTS age 21+ who...


	When an MLTC Plan Closes - What are the Members' Rights? WARNING - Changes Now in Effect Since Managed Long Term Care (MLTC) plan enrollment has been mandatory since 2013 for most adult "dual eligibles" (people with Medicaid and Medicare) who need Medicaid home care, some MLTC plans have either closed or reduced their service area, no longer covering certain counties or New York City....


	Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA) August 5, 2024 - address for main NYC Medicaid Office - called the Brooklyn South Medicaid office - has been changed to 495 Clermont Avenue, Brooklyn, NY 11238. This is around the corner from the previous address on Atlantic Avenue since 2013 see 2024-08-02 Change of address for Brooklyn_South...


	NYS Medicaid Codes - What do they Mean? This article has links to references for various codes for Medicaid eligibility and billing. 1. ELIGIBILITY CODES When you prepare for a fair hearing and obtain an evidence packet, and in some other instances, you obtain screenshots from the eMedNY system - the computer system that stores...


	Immigrant Eligibility for Medicaid & other Public Benefits Updated Immigrant Eligibility for Public Benefits in NYS Chart by Empire Justice Center & NY Immigration Coalition - updated Jan. 2026 - This chart is posted on this webpage. Scroll down on that page to see updates from the Trump H.R.1 "Big Beautiful" bill enacted in July 2025. ...


	Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Note: For a quick introduction to EPSDT, see the attached powerpoint titled "NYLAG Presentation on EPSDT." Please feel free to share those slides, as well as the material below, widely. In this article: Part 1 - Basics about EPSDT Requirements Part 2 - Select Services that Must be Covered...


	Income and Resource Limits for New York State Public Health Insurance Programs Since Jan. 1, 2023, the income limit for the Aged, Blind and Disabled is 138% of the Federal Poverty Level (FPL -also known as "Federal Poverty Guidelines"). This is the same income limit used since 2014 for the younger "MAGI" Medicaid group under the Affordable Care Act (ACA).. (Read about how the...


	List of Pooled SNTs in New York State This is an unofficial list of non-profit organizations in New York State that offer pooled Supplemental Needs Trusts (or similar services) to people with disabilities. We do not claim that this is an exhaustive list; there may be other pooled trusts in the state of which we are unaware. In...


	Sources of Legal Authority for Health Care Advocates Public health care programs in New York State are governed by many different legal sources. Because most programs, including Medicaid, are federal in origin, governing law begins with federal statute and regulation. State statutes are often very prescriptive as well, defining key terms such as...


	Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income" Many people age 65+, Disabled or Blind would normally have an income "spend-down" because their income is above the non-MAGI limits (which are in BOX 1 of the HRA Income & Resources chart ). This Fact Sheet explains the basic rules of Non-MAGI Budgeting used for people age 65+, Disabled, or...


	The Medicaid Buy-In for Working People With Disabilities (MBI-WPD) The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) expands eligibility for individuals with disabilities under age 65 who have work income. Under MBI-WPD, individuals are eligible for full Medicaid benefits at much higher incomes than individuals who are not working. The income...