New York Health Access - Recent Articles

Recent Articles

	Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes Nov. 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...


	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...


	Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility News update - Starting JAN.. 1, 2024 - Immigrants age 65+ can get FULL MEDICAID even if they do not qualify for PRUCOL status,discussed below. See this official Fact Sheet that explains how immigrants age 65+ can access full Medicaid - New Health Insurance Option for Undocumented Immigrants Over...


	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...


	Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State May 2024 ALERT - Learn about CDPAP changes adopted in final NYS FY 24-25 BUDGET - HERE - effective April 1, 2025 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,...


	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...


	Step-by-step guide to enrolling in a pooled income trust for Medicaid spend-down This article is a condensed road-map for using a pooled income trust to eliminate the Medicaid spend-down. NEW June 2022 - Big Changes in NYC - See STEP TWO and STEP Three below - NEW DISABILITY forms required! DOWNLOAD OUR our longer FACT SHEET on this topic (updated May 2024 to reflect...


	Nursing Home Medicaid Coverage - Basic Financial Eligibility Rules about Income, Resources, and Spousal Protections Medicaid rules are different for people living in the "community" than people living in institutions. For this article, the word "institution" means nursing home care. If you live in your home, someone else's home, or an Assisted Living Program, you are considered to live in the "community." ...


	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...


	Medicaid Assisted Living Programs (ALP) in NYS INTRODUCTION The Assisted Living Program provides supportive housing and home care services to individuals who are medically eligible for placement in a nursing facility but, whose needs can be met in a less restrictive and lower cost residential setting. he operator of the assisted living...


	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...


	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...


	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. and see these DOH directives: 3/1/24 UPDATE - NYS Dept. of Health updated the income and resource limits based on the 2024 Federal Poverty...


	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...


	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 June 2023) 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...