New York Health Access - Recent Articles

Recent Articles

	Medicaid Managed Care IN THIS ARTICLE * Complaints - Where to File *Law & Regulations 1 - What is Managed Care? 2 - Mandatory Enrollment for Most People with Medicaid - and LOCK-IN 3 - Who is Exempt or Excluded from Enroling in Managed Care 4 - Enrolling and Disenrolling in Managed Care 5 - List of plans in...


	Some Medicaid Recipients are "Default Enrolled" into Medicare Special Needs Plans when they Enroll in Medicare Since April 1, 2021 Background Every month about 3,000 - 4,000 Medicaid recipients in New York State become enrolled in Medicare, either because they reach age 65 or after they collect Social Security Disability Insurance (SSDI) for 24 months. They become "Dual Eligibles" when they have both Medicare and Medicaid. ...


	2025 Medicare Part D Plans in New York State - with changes from 2024 The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2025 runs from October 15 through December 7, 2024. For 2024 plan lists - click here. Read below for 2025 plan lists. Every year, you should review your plan options to see if...


	Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State May 2024 ALERT - Single Fiscal Intermediary to replace all FIs by April 2025 see here. 2023 UPDATE - see directives issued Oct. 2023 here clarifying that a legal guardian may be a personal assistant in CDPAP if someone else is the "designated representative. In 2020, NYS enacted restrictions...


	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...


	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 $174.70 in 2024. MIPP is for some groups who...


	Medicare Savings Programs (MSP) in New York Medicare Savings Programs (MSPs) pay for the monthly Medicare Part B premium for low-income Medicare beneficiaries, qualify enrollees for the "Extra Help" subsidy for Part D prescription drugs, and for those in QMB - pay Medicare coinsurance and deductibles. As of 2023, there are TWO separate...


	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...


	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 (formerly called the "Medical Insurance and Community Services Administration (MICSA)". The Medicaid Program is the part of New York City’s Human Resource Administration...


	Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility New York State Medicaid covers many immigrants not covered by federal law. Since 1996, federal Medicaid limits Medicaid eligibility to US citizens and “Qualified Aliens,” which include: Lawful Permanent Residents (LPR or “green card”) – under federal law, all but pregnant women...


	Medicaid for Undocumented Immigrants Age 65+ - Starts January 2024 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,...


	Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services NOTE: This article is about consumer rights when a Medicaid recipient "transitions" to or from a Managed Care plan. For information about care related to gender transitions, see Know Your Rights: What You Need to Know About Medicaid Coverage for Transition-Related Care. What is a Transition...


	NYS Medicaid Codes - What do they Mean? 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 Medicaid eligibility information, which providers use to look up eligibility of their patients. Local Medicaid offices or...


	KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars A. Fact Sheets on Managed Long Term Care B. Click here for WEBINARS on LONG TERM CARE A. Fact Sheets on Managed Long Term Care BASICS Basics on Managed Long Term Care (In process of being updated - 2-2020) see also Article on Managed Long Term Care News on MLTC - updated monthly ...


	Getting Help with Managed Long Term Care Here are organizations where you can seek help for problems with Medicaid Managed Long Term Care and Medicaid Advantage Plus. Also see these KNOW YOUR RIGHTS Fact Sheets about MLTC and related topics STATEWIDE ICAN – Independent Consumer Assistance Network – ...


	MLTC Members in Nursing Homes for 3+ Months Being Disenrolled from MLTC Plans - Since August 2020 In this article: Intro - What is the "Carve-out" of Nursing Home care from MLTC? Dashboard of Number of MLTC Members Disenrolled Procedures and Notices to Consumers for Disenrollment starting August 2020 Right to Re-enroll in the MLTC plan within SIX MONTHS after being...


	Maintaining Community Medicaid Budgeting and SSI Benefits During Temporary Nursing Home Stays Many Medicaid recipients are admitted to nursing homes but plan to return to their homes in their community. Financially, they need to maintain income so that they can continue to pay rent, utility, and other living expenses to preserve their apartment or home for their return. However, both...


	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...


	NYS Medicaid Application Form (updated 2021) for Age 65+ or Disabled or Blind - New Supp A NYC 2021 Since 2010, the New York State Department of Health Medicaid application form is called the Access NY Application or Health Insurance Application or form DOH-4220. Download the most recent version of the form at this link. (As of 02-06-24, the form was last updated in January 2023.) For those...


	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 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...


	"Immediate Need" Fast-Track Application for Medicaid and Personal Care or CDPAP - Choices for those with full Medicaid start April 2024 Medicaid has a fast-track procedure to apply for Medicaid in order to obtain home care services, which has been faster than enrolling in a managed long term care plan. Click here to learn about the reasons for MLTC enrollment delays. The 2015 New York law requires approval of Medicaid in only...


	When Documentation of Resources and Income is Required for Medicaid Applications & Renewals - and When is "Attestation" Enough? Since 2004, Medicaid documentation requirements have been simplified by allowing some applicants merely to "attest" rather than document certain eligibility factors. In that year, attestation to the amount of one's resources was first allowed for Medicaid applicants who were not seeking Medicaid...


	Right to a "Home Hearing" under Varshavsky Case - Special Rights in Fair Hearings Seeking Increases in Medicaid Home Care RIGHTS of People Who Cannot Travel to a Fair Hearing Because of Disability This article can also be downloaded as a Fact Sheet here. Individuals who, because of mental or physical disabilities, cannot travel to a fair hearing without substantial hardship or medical detriment, have rights...


	How to use a pooled SNT to eliminate the Medicaid spend-down. This Fact Sheet explains how to use a Pooled Supplemental Needs Trust to eliminate the Medicaid spend-down (updated for 2024) - See SPANISH TRANSLATION. N. Y. Social Services Law § 366, subd. 5 (f) - Law enacted Dec. 18, 2017 - NEW LAW enacted that requires the State Dept. of Health to...