New York Health Access - Recent Articles

Recent Articles

	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...


	Medical Records Must be Provided FREE if Needed to Support Claims for Public Benefits - New September 2017 In September 2017, a new law went into effect that requires health care providers to provide medical records at no charge, when needed to support an application, claim or appeal for a government benefit or program. Here's what the law adds to Mental Hygiene Law § 331 and NYS Public Health Law §...


	List of Pooled SNTs in New York State This is an unofficial list of non-profit organizations in New York State that offer pooled Supplemental Needs Trusts (or similar services) to people with disabilities. We do not claim that this is an exhaustive list; there may be other pooled trusts in the state of which we are unaware. In...


	How to Prevent and Fix Medical Debt This handbook was designed for community advocates who assist New Yorkers with medical debt. The handbook covers the following: common billing problems faced by uninsured and underinsured patients, how to get financial assistance with hospital bills, how to deal with collection agencies, and what...


	2024 Medicare Part D Plans in New York State - with 2023 plans The Annual Enrollment Period ("AEP" or "open enrollment") for Medicare Part D and Medicare Advantage plans for 2024 runs from October 15 through December 7, 2023. For 2023 plan lists - click here. Read below for 2024 plan lists. Every year, you should review your plan options to see if...


	Annual Open Enrollment Period for Qualified Health Plans Begins November 16, 2023 The annual open enrollment period for Qualified Health Plans on the New York State of Health exchange starts November 16, 2023. Go to the New York State of Health website to look at plan options and enroll. You must enroll by December 15, 2023 for coverage starting January 1, 2024. Even if you...


	Medigap (Medicare Supplemental) Policies and Rates in New York State - with Rate Tables for the Current Year Medigap (aka Medicare supplemental insurance) policies are sold by private health insurance companies to cover some of the "gaps" in expenses not covered under original Medicare. Different Medigap policies in New York State and their Cost. Under federal law, all Medigap plans have standard...


	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...


	Long Term Care Insurance Long term care insurance is a product which, if certain requirements are met, will pay for all or a portion of nursing home and/or home care expenses. Such policies are sold to individuals who do not wish to have their assets depleted should they need long term care. While such policies are...


	Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes Nov. 2023 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...


	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." ...


	The Medicaid Pharmacy Benefit - For People Without Medicare - NYRx Implemented April 1, 2023 Once again, in April 2023, NYS changed the way people without Medicare access prescription drugs. These are people in "mainstream" Medicaid managed care plans, including HARP and HIV-SNP plans. These changes were delayed from 2021, but are in effect as of April 1, 2023. These were enacted under...


	Extra Help - The Part D Low Income Subsidy and How to Get It - 2024 Changes "Extra Help" is the federal subsidy program that helps with Medicare Part D cost sharing - reducing premiums, deductibles, and copayments. It is also called the Low Income Subsidy (LIS). This article will tell you: Costs Savings of Extra Help - Good Changes in 2024! How to enroll in...


	Public Health Insurance Programs in New York State Updated Public Health Insurance Programs in New York State (2023) These materials include an overview of public health insurance programs in New York and in-depth information on Medicaid managed care.


	New York Medicaid Expansion Know Your Rights: What You Need to Know About NYS Medicaid Expansion in 2023 This year’s Health Budget makes significant changes to New York’s Medicaid program – expanding eligibility to 133% of the federal poverty law (FPL) and changing budgeting rules and enrollment processes for...


	Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services Know Your Rights: What You Need to Know About Medicaid Coverage for Transition-Related Care States must have in effect a transition of care policy to ensure continued access to services during a transition from Fee for Service Medicaid (FFS) to a Managed Care plan or transition from one Managed...


	Dental and Orthodontic Services to be Included in the Medicaid Managed Care Benefit Package Know Your Rights: What You Need to Know About the Expansion of Medicaid Dental Coverage in NYS (2024) 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...


	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: 2/10/23 UPDATE - NYS Dept. of Health updated the income and resource limits based on the 2023 Federal Poverty...


	Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility NEWS UPDATE March 9, 2021 - The Trump Public Charge rule has been vacated after the Biden administration withdrew its appeal to the Supreme Court of an injunction issued by the Second Circuit and also withdrew appeal of a Seventh Circuit lawsuit. See more about this news and public charge here. ...


	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...


	Medicaid Managed Care Law and Regulations STATE - N.Y. Soc. Servs. L. §364-j (Amended L. 2011 Ch. 59). Regulations at 18 NYCRR 360-10. FEDERAL - 42. C.F.R Part 438 (amended extensively in 2016, with changes going into effect in NYS on rolling basis, including new appeal rules starting May 1, 2018 requiring...


	Requesting a New or Increased Service from a Medicaid Managed Care or MLTC Members of Medicaid Managed Care plans, including Managed Long Term Care (MLTC) plans, have the right to request a NEW service that was not previously authorized ("prior authorization"), or an INCREASE In a service they already have ("concurrent review"), such as more hours of personal care or...


	Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants Coming January 2024 - Undocumented immigrants age 65+ will be eligible for full Medicaid (as opposed to only emergency Medicaid). Current emergency Medicaid recipients who are 65+ should receive a notice in November 2023 alerting them to the change. This will be posted here when available. ...


	Medicare Part D - Overview The Evelyn Frank Legal Resources Program has these resources for counseling Medicare beneficiaries and assisting them in accessing prescription drugs through the Medicare Part D program. See lists of 2024 and 2023 Part D plans which show the most recent plan closings and changes in NYS. NYLAG...


	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...