New York Health Access - Recent Articles

Recent Articles

	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) take effect Jan. 1, 2023 - read about how these will be rolled out here. and see these DOH directives: 2/10/23 UPDATE - NYS Dept. of Health updated the income and resource limits based on the 2023 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...


	Medicaid Home-and-Community-Based Waiver Programs in New York State Medicaid home and community-based services [HCBS] are available through waiver programs to groups of individuals who would be eligible for Medicaid if institutionalized and, but for the services, would be institutionalized in a hospital or nursing facility. Under section 1915(c) of the Social...


	What You Need to Know About the Expansion of Medicaid Dental Coverage in NYS By the Legal Aid Society Thanks to a settlement secured by Legal Aid in Ciaramella v. McDonald many more New Yorkers will be eligible for additional dental procedures under Medicaid by early 2024. What dental services does the settlement impact? Root canals, crowns, dental implants, and...


	Dental and Orthodontic Services to be Included in the Medicaid Managed Care Benefit Package Dental Services to be Included in the Medicaid Managed Care Benefit Package Effective July 2, 2012, dental services for Medicaid beneficiaries must be obtained through the member's Medicaid managed care plan, if they are in such a plan. Previously, Medicaid managed...


	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 Contacts in New York City (NYC Human Resources Administration - MICSA) Since May 2013 the NYC Medicaid Office has been located at 785 Atlantic Ave., Brooklyn, NY 11238. The Reception Unit is on the main floor of 785 Atlantic Ave.Brooklyn NY 11238. The table of contacts below is compiled from these Alerts issued by HRA: See HRA Fax/E-mail Submissions to HRA...


	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...


	Resources for Uninsured and Underinsured This article briefly explains how uninsured people those without Medicare, Medicaid, or private health insurance may obtain help with hospital, prescription drug and other medical bills. First is a brief explanation of New York's Hospital Financial Assistance or Charity Care law, with a longer...


	Medicaid Recipients to be "Default Enrolled" into Medicare Special Needs Plans when they Enroll in Medicare-- April 1, 2021 .  WHAT CHANGE IS HAPPENING APRIL 1, 2021 Beginning April 1, 2021, a change is coming for New York Medicaid recipients who newly become enrolled in Medicare and become "Dual Eligibles" - someone who has both Medicare and Medicaid. Every month about 3,000 - 4,000 Medicaid recipients in New...


	Medicaid Renewals/Recertifications in NYC- Resume March 2023 - Now can file online! This article available as a fact sheet in ENGLISH and SPANISH This article is for people whose Medicaid is administered by the NYC Medicaid program, run by the Human Resources Administration (HRA). If your Medicaid is handled by the New York State of Health – your renewal is not covered in...


	Appeals & Grievances in Managed Long Term Care - "Exhaustion" of Plan Appeal Required since 2018 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...


	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 deductibes. In 2023, there are now TWO separate...


	Sources of Legal Authority for Health Care Advocates Public health care programs in New York State are governed by many different legal sources. Because most programs, including Medicaid, are federal in origin, governing law begins with federal statute and regulation. State statutes are often very prescriptive as well, defining key terms such as...


	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 2023 to reflect...


	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 2023) - 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...


	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 ...


	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 $164.90 in 2023. MIPP is for some groups who...


	Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans 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 or Consumer Directed Personal Assistance Program (CDPAP) services, with some exceptions. See also DOH list of exclusions...


	Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State COVID-19 updates & Eligibility Restrictions CDPAP services are still available from MLTC and managed care plans, for people applying for "Immediate Need" services, or who are exempt from MLTC or managed care during COVID-19. People who want to register with a "Fiscal intermediary" to be paid...


	What You Need to Know About NYS Medicaid Expansion in 2023 By the Legal Aid Society Many Medicaid recipients who are 65+, and/or who have a disability and receive Medicare, are now able to have higher income and more resources while still qualifying for Medicaid. Improvements to Medicaid Medicaid recipients who are 65 and over, and/or who have a...


	What You Need to Know About Using Medicaid to Get Health Care By The Legal Aid Society This guide will answer common questions about how to use your Medicaid to get health care services. It will cover: Understanding Your Medicaid Plan Finding a Doctor Getting Care Appealing a Denial Understanding Your Medicaid Plan Do I have Medicaid through...


	What You Need to Know About Medicaid Spenddowns By the Legal Aid Society A Medicaid spenddown is when your monthly income is more than the income limit for Medicaid. The difference between your income and the Medicaid limit is called a “spenddown” or a “surplus.” You also might be told you are “over-income” for Medicaid or have...


	What You Need to Know About Lump Sum Payments and Medicaid Eligibility By the Legal Aid Society Information about receiving a lump sum payment from Medicaid and how it may affect your eligibility or coverage. If I receive a lump sum payment, like a court settlement, workers’ compensation payment, or inheritance, will it affect my Medicaid coverage? How a lump...


	What You Need to Know About Insurance and Court-Ordered Behavioral Health By The Legal Aid Society New York and federal law requires health insurance – including Medicaid, Child Health Plus, and private insurance – to cover most court-ordered behavioral health treatment when medically necessary. What is medical necessity? It means that your doctor (and/or...