New York Health Access - Recent Articles

Recent Articles

	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....


	2026 Medicare Part D Plans in New York State - with changes from 2025 The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2026 runs from October 15 through December 7, 2025. For 2025 plan lists - click here. Read below for 2026 plan lists. Every year, you should review your plan options to see if...


	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 This article for latest news and this article for the history of the transition to PPL starting in 2024 with links to press coverage. Also see...


	CDPAP: April 2025 Transition to PPL as Single Fiscal Intermediary - Background & 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...


	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...


	Getting Help with Managed Long Term Care and Other Types of Medicaid Managed Care Here are organizations where you can seek help for problems with Medicaid Managed Long Term Care (MLTC) plans, Medicaid Advantage Plus (MAP) plans, and Mainstream plans. Also see these KNOW YOUR RIGHTS Fact Sheets about MLTC and related topics STATEWIDE ICAN –...


	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 ...


	ARCHIVE: US Lawsuit Against NYC for "False Claims" - Says HRA Wrongly Approved 24-Hour Medicaid Home Care On August 12, 2011, Selfhelp Community Services, New York Lawyers for the Public Interest, Legal Services-NYC, and Cardozo Bet Tzedek Legal Services led 41 organizations in filing an amicus or "friend of the court" brief supporting the New York City Medicaid Program, run by the Human Resources...


	Spousal Impoverishment Protections for Married Couples where One Spouse is in a Managed Long Term Care Plan - Pooled Trusts Allowed as an Option 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...


	Statistics on Medicare and Medicaid Managed Care -- Enrollment Numbers and other Data -- New York State Numbers tell a big part of the story of how managed care plans are doing in providing care. With mandatory enrollment in Medicaid managed care now required in every county in New York State for most people who do not have Medicare, and mandatory enrollment in Managed Long Term Care of those adults...


	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 Reimbursement of Home Care and other Medical Expenses Reimbursement in General Because Medicaid coverage can be retroactive up to three months, it is possible for a Medicaid applicant or his or her family member who paid the applicant's medical expenses to get reimbursed for some of the home care costs and other medical bills they incurred and paid...


	KNOW YOUR RIGHTS: Fact Sheet Explaining Basic Rules on NYS Financial Medicaid Eligibility for People who are Disabled, Aged 65+, or Blind This Fact Sheet (updated 03/05/2025 with 2025 figures) explains Medicaid eligibility for New Yorkers who are age 65+ or who have disabilities. It explains the basic financial rules on eligibility for Medicaid in the community for this category of people, and explains how to apply for Medicaid if...


	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...


	"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...


	Transfer of Asset Rules in Medicaid -- The Deficit Reduction Act of 2005 The Deficit Reduction Act of 2005 (DRA, enacted in 2006, made major changes to the transfer penalty rules for eligibility for Medicaid to pay for nursing home care. At the time, and until now, nursing home care was the only Medicaid service that had a lookback and transfer penalty.See GIS 06...


	Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services - Including Providers in Managed Care Plans - also Tool to Find Medicaid Providers What types of providers are affected? Effective January 1, 2014, medical providers must be enrolled with the NY State Medicaid program in order for Medicaid to pay for services that they prescribed, ordered or referred. The rule applies to ordering, prescribing, referring and attending...


	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...


	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"...


	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...


	Applying for Medicaid Personal Care or CDPAP Services in New York City - 2021-2022 Changes May 16, 2022 Update - The new NY Independent Assessor (NYIA) starts being phased in. See info about that huge change in this article. Starting May 16, 2022 the M11q is no longer required for people applying to HRA for Medicaid home care who are NOT seeking MLTC because they are exempt or excluded...


	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...


	Grievance and Appeal Contacts for Managed Long Term Care Plans SINCE MARCH 1, 2018, members of Medicaid Managed Care and Managed Long Term Care plans will be required to request an INTERNAL APPEAL within their plan, and wait until the plan decides that appeal before they may request a FAIR HEARING when they receive an Initial Adverse Determination denying or...


	Special Income Standard for Housing Expenses: If Discharged from Nursing Homes or Adult Homes & Enroll in or Remain Enrolled in MLTC Plan A huge barrier to people returning to the community from nursing homes is the high cost of housing. One way New York State is trying to address that barrier is with the Special Housing Disregard that allows certain members of Managed Long Term Care or FIDA plans to keep more of their income to pay...


	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. ...