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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. ...
Transition Rights in Managed Care Plans - Rights of New Enrollees to Continue Receiving Services
NOTE: This article is about consumer rights when a Medicaid recipient "transitions" to or from a Managed Care plan. For information about care related to gender transitions, see Know Your Rights: What You Need to Know About Medicaid Coverage for Transition-Related Care. What is a Transition...
KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars
A. Recent and Upcoming Presentations and Recorded Webinars View recording of Medicaid Home Care Update and download Powerpoint presented at the Elder Law Forum on May 14, 2026 - Presenter Valerie Bogart (All recordings at the forum are here - this presentation is the "Medicaid Home Care Update."...
Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes start June 1, 2026
Introduction, Updates and Definitions 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...
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 Administration...
Medicaid Managed Care
IN THIS ARTICLE * Complaints - Where to File *Law & Regulations & Model Contracts, CMS Special Terms & Conditions 1 - What is Managed Care? 2 - Mandatory Enrollment for Most People with Medicaid - and LOCK-IN 3 - Who is Exempt or Excluded from Enroling in Managed Care 4 -...
NEW YORK INDEPENDENT ASSESSOR PROGRAM (NYIAP) - How Medicaid Home Care Eligibility is Assessed
What is the NY Independent Assessor Program? The Basics In 2020, a NYS law was enacted that required an "independent assessor" to assess the need for and approve personal care, CDPAP, and Managed Long Term Care (MLTC) enrollment. For MLTC, this was not new because the COnflict-Free...
Requesting a New or Increased Service from a Medicaid Managed Care or MLTC
Introduction and News Alerts Members of Medicaid Managed Care plans, including Managed Long Term Care (MLTC) plans, have the right to request a new service or more of the same service they already receive. This article explains the rules about when the plan must make a decision on these requests....
Right to a "Home Hearing" under Varshavsky Case - Special Rights in Fair Hearings Seeking Increases in Medicaid Home Care
This article can also be downloaded as a Fact Sheet here. INTRODUCTION Individuals who, because of mental or physical disabilities, cannot travel to a fair hearing without substantial hardship or medical detriment, have rights under an injunction in a class action called Varshavsky. Read...
Transition Rights after Enrolling in or Switching MLTC plans - 2022 Changes
INTRODUCTION If you received Medicaid personal care or Consumer-Directed Personal Assistance (CDPAP) services, and then you were required to enroll in or transfer to a different Managed Long Term Care plan, your new Plan must continue to authorize the same amount and type of home care...
Managed Long Term Care
KEY MLTC Complaint Line, Other Contacts and INTRODUCTION State MLTC Complaint Unit - MLTCComplaints@health.ny.gov or 1-866-712-7197 Enrollment complaints - call NY Medicaid Choice - 1-855-886-0570 (Advocates line) or 1-888-401-6582 (Consumers line) Report problems with...
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State - Big Changes Coming 2025!
Introduction and links to info about transition to the new NYS "Single Fiscal Intermediary" (FI) 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 https://nylag.org/engesser/ for info about...
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...
Patients' Rights in the Health Care System
See NYS Dept. of Health Webpage on Patient Rights in NYS Managed Care Bill of Rights New York State has a fairly progressive managed care bill of rights which is found in both the Public Health and Insurance laws. Disclosure. Managed care plans must tell their patients about the coverage...
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 Advantage Plus "MAP" - Changes in Integrated Appeals & Hearing Process - Jan. 1, 2026
Introduction and NEWS ALERTS - Change in MAP Appeals Process starting Jan. 1, 2026 2025 UPDATE - The integrated appeal and fair hearing process launched in 2020 for members of Medicaid Advantage Plus (“MAP”) plans is being phased out to end December 31, 2025. See the DOH MAP Integrated Hearings...
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...
Tools for Choosing a Medicaid Managed Long Term Care Plan
As described in this article, most adults in NYS who have Medicaid and Medicare, who need Medicaid personal care or CDPAP services or long-term CHHA or adult day care services, must select and enroll in a managed long term care plan, or a PACE or Medicaid Advantage Plus plan. Starting in May 2022...
"HARP" Plans for Managed Care Members who need Behavioral Health Services - 2026 Changes for Members New to Medicare
For many years, behavioral health services were "carved out" of the Medicaid managed care benefit package. This means that most behavioral health services were accessed on a fee for service basis from Medicaid providers outside of the member's managed care plan. In this Article: What is a...
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.
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