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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...
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...
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...
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 ...
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...
Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants & Changes for Age 65+
NEWS ALERT: January 1, 2024 - Undocumented immigrants age 65+ became eligible for full Medicaid (as opposed to only Emergency Medicaid). See this article to learn how this expansion is being implemented, and Download the official Fact Sheet - New Health Insurance Option for...
NYS Essential Plan - Expands April 2024 from 200% to 250% Federal Poverty Level
The NYS Essential Plan (EP) will have expanded eligibility levels starting April 1, 2024, under a recently approved federal 1332 Waiver program. Until now, EP covered individuals who are over income for Medicaid (with incomes between 139%-200% of the FPL) and some lawfully present immigrants who...
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...
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,...
Medicaid Transportation in NYS
States are required under federal regulations (42 C.F.R. §431.53) to assure necessary transportation to Medicaid beneficiaries to and from medical services. When travelling to medical appointments, a Medicaid beneficiary is expected to use the same mode of transportation as the beneficiary...
Expanded Medicaid Dental Benefits - Effective 1/31/24
New York’s Medicaid program includes limited dental benefits. The coverage has been expanded beginning on January 31, 2024 as the result of the settlement of the Ciaramella v. McDonald case (originally Ciaramella v. Zucker). This article will go over general Medicaid dental rules and common...
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...
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...


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