New York Health Access - Recent Articles

Recent Articles

	Extra Help - The Part D Low Income Subsidy and How to Get It - 2024 Changes "Extra Help" is the federal subsidy program that helps with Medicare Part D cost sharing - reducing premiums, deductibles, and copayments. It is also called the Low Income Subsidy (LIS). This article will tell you: Costs Savings of Extra Help - Good Changes in 2024 and 2025! How to...


	Medicaid Spend-Down Because Medicaid is a health insurance program for the poor, one must have income and assets below a certain limit to be eligible. For a single elderly or disabled person in New York State in 2025, the income limit is $1800/mo. of income. (after subtracting $20/mo disregard) (The income limits for...


	Medicaid for Undocumented Immigrants Age 65+ - Starts January 2024 June Starting Jan. 1, 2024, immigrants age 65+ can get FULL MEDICAID even if they do not qualify for PRUCOL status (PRUCOL is discussed in this article). This include most services - including home care, prescription drugs, and Nursing Home care. See more below about services covered. Until now,...


	Advocate's Outline on Supplemental Needs Trusts and Rules for Impact of Lump Sums on Various Benefits This in-depth training manual or outline (updated July 2025) covers how Supplemental Needs Trusts work (both individual and pooled), when an asset or lump sum may be deposited into an SNT. For Community Medicaid only, income may also be placed into an SNT. Explains how lump sums and SNTs affect...


	Medicaid Home-and-Community-Based Waiver Programs in New York State June 2025 ALERT: NYS DOH has proposed to cap the number of people who may enroll in the Nursing Home Transition & Diversion Waiver (NHTD). See more here. IN THIS ARTICLE Introdution to Home & Community Based Waivers Traumatic Brain Injury (TBI) waiver Nursing Home Transition &...


	Medicaid Advantage Plus "MAP" - New "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 Jan. 1, 2026. See the DOH MAP Integrated Hearings Phase-out plan here. Some integrated hearings will still be held after Jan....


	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...


	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...


	2025 Medicaid Fair Hearing Compliance Plan = "Pre-Hearing Dispositions" or PHD's In New York, there are over 10,000 Medicaid fair hearings pending past the 90-day deadline. The backlog grew significantly during the COVID-19 Public Health Emergency and is the largest in the nation. To address the backlog and avoid corrective action, the Department of Health (DOH) announced a...


	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...


	Medicaid Copayments in New York State This fact sheet - updated July 2025 explains which New York Medicaid recipients must pay copayments, and for which services. It also explains the $200 CAP, which limits how much any Medicaid recipient must pay in copayments in a year to $200. Note that for those who have both Medicare and...


	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...


	Medicaid Personal Care or Home Attendant Services The Medicaid program in New York State covers a type of home care services called Personal Care services (aka PCS or "home attendant"). This is a service under NYS's "State Medicaid Plan," which means that the rules described here apply whether the consumer receives it under fee-for service from...


	NEW YORK INDEPENDENT ASSESSOR PROGRAM (NYIAP) - How Medicaid Home Care Eligibility is Assessed IN THIS ARTICLE: What is the Independent Assessor? Click here for the basics. Two Official Websites about NYIA When does NYIA Start? Contacts - Where to Submit Complaints, How to Request an Evidence Packet, How to Submit a Power of Attorney NYIA CONSENT FORM - Where to...


	Appeals & Grievances in Managed Long Term Care & Managed Care In 2016, CMS adopted changes in federal Medicaid managed care regulations requiring "exhaustion" of Plan Appeals prior to requesting a Fair Hearing. These changes became effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F. NYLAG 2018 Trainings on Changes: View the...


	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...


	COBRA - Keeping Employer Group Health Insurance After a Job Ends - Federal & New York State Protections Here are resources on rights to continue coverage after losing one's job, under the federal "COBRA" law and related NYS protections. FEDERAL INFO on COBRA US Dept. of Labor COBRA Webpage NYS COBRA INFO NYS Dept. of Financial Services COBRA website Unmarried children up to...


	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....


	CASA Contact List - NYC The NYC Medicaid Home Care Services Program, which is part of the NYC Human Resources Administration Medical Insurance Community Services Administration (MICSA), also known as the Medicaid program, formerly was responsible for administration in NYC for three types of Medicaid "personal care"...


	Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State - Big Changes Coming 2025! For updates about the transition to the new NYS "Single Fiscal Intermediary" (FI) and NYLAG's lawsuit challenging it - please see See this article for latest news and links to press coverage. See more about litigation and advocacy here. On March 10, 2025 the Albany Times-Union in an...


	Medicaid Disability Determinations - NYS Forms & Procedures (with updated forms Dec. 2021) The Medicaid program has long had a procedure for determining disability for individuals who have not yet been determined disabled by the Social Security Administration.[1] This procedure is needed in order to approve pooled trusts for people age 65+ and also for other reasons described here. The...


	Income and Resource Limits for New York State Public Health Insurance Programs Big increases in income and asset limits for Age 65+, Blind & Disabled (ABD) took effect Jan. 1, 2023 - read about how these were rolled out here. Terminology note - The "Federal Poverty Levels" (FPL) are the same thing as the "Federal Poverty Guidelines." Sometimes you will see these terms...


	Medicare Insurance Premium Payment Program (MIPP) Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $185 in 2025. MIPP is for some groups who are...


	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...