|
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. Jan. 8, 2025 UPDATE - HRA and NYS Dept. of Health issued 2025 charts of income and resource limits, but most of the levels are unchanged from...
|
|
|
|
|
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State - Big Changes Coming 2025!
January 2025 ALERT - Transition to a "Single Fiscal Intermediary" (FI) starts now, requiring all consumers in CDPAP to transition from their current to the new single FI "PPL" by April 2025. See here for links to information from State DOH, CDPAANYS, and PPL and links to press coverage In...
|
|
|
|
|
Applying for Medicaid Personal Care Services and CDPAP Outside NYC - 2016 Changes
New York State's Medicaid program covers personal care services and consumer-directed personal assistance services. The model for delivery of those services has, in the years since 2011, gradually transitioned from the local departments of social services, through their Medicaid programs, to...
|
|
|
|
|
"Qualified Medicare Beneficiaries" (QMB) - Protections against "Balance Billing"
THE PROBLEM: Meet Joe, whose Doctor has Billed him for the Medicare Coinsurance Joe Client is disabled and has SSD, Medicaid and Qualified Medicare Beneficiary (QMB). His health care is covered by Medicare, and Medicaid and the QMB program pick up his Medicare cost-sharing obligations. Under...
|
|
|
|
|
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...
|
|
|
|
|
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...
|
|
|
|
|
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...
|
|
|
|
|
Managed Long Term Care
State Complaint Number for MLTC Problems - 1-866-712-7197 e-mail mltctac@health.ny.gov and put "COMPLAINT" in subject line For enrollment complaints - call NY Medicaid Choice - 1-855-886-0570 (Advocates line) 1-888-401-6582 (Consumers line) Managed Long Term Care (MLTC)...
|
|
|
|
|
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...
|
|
|
|
|
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...
|
|
|
|
|
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 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...
|
|
|
|
|
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...
|
|
|
|
