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Most downloaded
Medicaid income and resource levels - 2026 (02-23-2026)
MAPDR-01 HRA NYS Medicaid Income + Resource Chart 2-23-26.pdf
NYC HRA MAPDR-01 (updated 02/23/2026) -- Final 2026 chart with 2026 Federal Poverty LImits
24 Feb, 2026
2.15 mb
Downloads: 456946
NYS Medicaid Income and Resource Levels for Past Years - 2017 - 2024
2017_to_2025_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2017- 2024. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
File got too big to include all charts since 2001. Years 2001 -2016 now posted at http://www.wnylc.com/health/download/920/
19 Jan, 2026
3.57 mb
Downloads: 303660
Medicaid Eligibility in 2014
Understanding MAGI & the Marketplace.pdf
Training provides framework for understanding the changes to Medicaid effective 2014, including: new categories, new income levels, new budgeting and new benefits.
15 Nov, 2013
1.56 mb
Downloads: 272466
Supplemental Needs Trusts Outline for Advocates - Including Impact on Various Benefits of Transfers of Lump Sums into SNT's Updated 7/2025
SNT Outline NYLAG 2025-07 FINAL.pdf
Training Outline for Advocates on Supplemental Needs Trusts (SNTs) (individual and pooled), and the effect of SNTs and lump sums on various public benefit programs (updated 7/31/2025). Updated sections include Temporary/Public cash assistance, SNAP, ABLE account changes coming in 2026, Public Housing and Section 8, changes in procedures for submitting pooled trusts in NYC.
31 Jul, 2025
1.18 mb
Downloads: 221261
Directory of MICSA (NYC Medicaid) Contacts - August 2013
MICSA Directory (08-06-13).pdf
NYC Medicaid office moved from 330 West 34th Street to 785 Atlantic Avenue, Brooklyn NY 11238 in May 2013. Contact numbers at that office listed in this document.
15 Aug, 2013
3.07 mb
Downloads: 207081
Medicaid Spend-Down Training Outline
spendownOUTLINE09.pdf
Comprehensive outline published by Selfhelp, covering the many strategies for obtaining Medicaid coverage in New York through the Excess Income Program. Updated 5/29/09.
19 Jul, 2010
279 kb
Downloads: 205903
Basic Eligibility for Medicaid and Home Care in NYS - Age 65+, Disabled, Blind
Medicaid Basic - 2026 FINAL.pdf
This is basic information about Medicaid eligibility for the Disabled, Aged 65+, and Blind (DAB) category and about applying for Community Medicaid in order to receive home care (personal care or consumer-directed personal assistance) through Managed Long Term Care or based on Immediate Need through the local Medicaid program. (updated March 12, 2026 with final 2026 Income and Asset limits released by DOH)
12 Mar, 2026
292 kb
Downloads: 203380
Pre-Paying for Burial – Tip for Qualifying for Medicaid despite “Excess Resources”
Funeral Agreement Fact Sheet revised 2020-10-28.pdf
This advocacy memo from NYLAG explains the rules regarding treatment of pre-paid funeral agreements for burial arrangements for Medicaid eligibility for people age 65+, blind, or disabled.
28 Oct, 2020
1000 kb
Downloads: 175373
Using an SNT to Eliminate the Medicaid spend-down - Fact Sheet (May 2024)
SNT Short 2024-05-02 FINAL.pdf
How to get Medicaid despite having "excess income" - Using a Supplemental Needs Trust to Eliminate the Spend-down for Persons who are Elderly (65+), Blind or Disabled. Written by New York Legal Assistance Group Evelyn Frank Legal Resources Program, updated May 2024 with new procedures in NYC for submitting disability forms, and with 2024 figures.
2 May, 2024
450 kb
Downloads: 172233
Medicaid Income Disregards
IncomeDisregards.pdf
This table lists all of the different sources of income that are excluded from countable income for Medicaid purposes, indicating which categories of Medicaid the exclusion applies to and citations to authority.
Note: do not use for MAGI Medicaid eligibility effective 1/1/2014. Updated 10/7/2013.
7 Oct, 2013
106 kb
Downloads: 125464
Home Health Aide Scope of Tasks
home_health_aide_scope_of_tasks DOH 06.pdf
Guidance issued by the New York State Department of Health to Certified Home Health Agencies (CHHA) on what tasks are permitted to be performed by Home Health Aides (HHA). Dated April 2006.
30 Mar, 2010
163 kb
Downloads: 122491
Medicaid Waivers in New York State
Medicaid Waivers Outline.pdf
This outline provides background on the various Home and Community Based Services (HCBS) Waiver Programs in New York State, with statutory and regulatory references.
2 Sep, 2010
221 kb
Downloads: 119613
LIST OF FIDA PLANS with Affiliated MLTC and Medicaid Advantage Plus plans
NYLAG FIDA -- LIST OF PLANS & MLTC Enrollment CORRECTED.pdf
List of FIDA Plans in FIDA Demonstration area (NYC, Long Island and Westchester) with current enrollment in MLTC and MAP plans in demo area (11/2014) CORRECTED 12/17/2014
17 Dec, 2014
1.18 mb
Downloads: 102285
HRA MAP 259d Nursing Home Discharge Alert - for Community Budgeting & Related Forms with various forms updated as of 3-24-2023
MAP-259d-e-f-g-t Discharge Alert and Related Nursing Home Forms as of 2023-03-24 (259f -259t+ 648p).pdf
NYC MICSA Medicaid Alerts from 2015 and 2020 with nursing home forms updated as of 3/23/23 including "Discharge Alert" 259d that nursing home physician must sign to certify that resident has a reasonable expectation to return home, which entitles resident to community budgeting (non-chronic care) - so they keep entire community Medicaid allowance rather than only $50/month. Form replaces 1159. PDF includes - Form 259f Notice of Discharge revised 2020 (now includes check-off that resident advised of Special Income Standard for those discharged from NH to MLTC) ; Form 259e (Change/Cancellation of Discharge Plan), 259g (Respite Alert), 259t (updated 5/2020) -- PDF has updated forms as of 3/24/2023 from NYC MARC website.
25 Mar, 2023
3.04 mb
Downloads: 78062
Medicaid Copyayments
Copayments NYS (2025-7).pdf
Fact Sheet Explaining Medicaid Copayments updated July 2025
16 Jul, 2025
397 kb
Downloads: 74434
CASA Contact List
CASA List (HCSP-3037 English) 12-4-2023.pdf
HRA contacts for the New York City Home Care Services Program CASA offices (updated 12/2023)
18 Mar, 2024
74 kb
Downloads: 72738
MAP-2161 and MAP 2161a Spousal / Parental Refusal Form (2025) (ENGLISH)
MAP-2161 (2025-04) + MAP-2161a (2025-3) Combined (Spousal Refusal Form with INSTRUCTIONS.pdf
Applicants for Medicaid in New York City can use this "APPLICANT/RECIPIENT DECLARATION CONCERNING THE LEGALLY
RESPONSIBLE RELATIVE’S INCOME/RESOURCES" forms to indicate the refusal of their legally responsible relative to make available their income or resources for the cost of necessary medical care and services, i.e. "spousal/parental refusal." Since 2018, includes language to request accommodation of disability in reading notice. Instructions explain whi h form to use - MAP-2161 or 2161a - don't need both. Both attached in same PDF. Other languages availaable of MAP-2161 at https://www.nyc.gov/site/hra/help/health-assistance.page
13 Jan, 2026
371 kb
Downloads: 70272
State Dept of Health and NYC HRA Medicaid program contacts
Medicaid phone list.pdf
NYC Medical Insurance & Community Services Administration (MICSA) CONTACT LIST
with some NYS Dept. of Health contact information Compiled by NYLAG Evelyn Frank Legal Resources Program
14 Jan, 2014
224 kb
Downloads: 64581
MAPDR-05 (08/04/2022) List of Managed Care & Managed Long Term Care Plans in NYC
2022-08-04 MAPDR-05 Medicaid Managed Care Plans NYC.pdf
This includes a list of all managed care organizations participating in the following types of Medicaid managed care, including ID and code numbers, contact information, and service areas:
* Medicaid Managed Care * Health and Recovery Plan Managed Care Plans (HARP) * Managed Long Term Care (MLTC) * Medicaid Advantage Plus (for dual eligibles, includes MLTC) * HIV Special Needs Plans (SNP) * Programs of All-inclusive Care for the Elderly (PACE) * Fully Integrated Dual Advantage (FIDA) IDD Updated August 4, 2022 (current on HRA site as of 5/31/23)
31 May, 2023
129 kb
Downloads: 63719
Sample HRA QMB Recertification Form
DAB Renewal.pdf
Sample of new recertification form that specifically refers to QMB. Actual recertification form will be prepopulated with the QMB recipients information. In use as of January 2010.
11 Jun, 2010
166 kb
Downloads: 59533
Training Outline: Medicaid Provisions in the Deficit Reduction Act of 2005
OutlineDRA.pdf
Detailed training outline for advocates, published by Selfhelp, regarding the changes to Medicaid eligibility wrought by the DRA. Includes changes to the transfer penalty rules, look-back period, strategies to avoid a transfer penalty, the new home equity cap, and the treatment of annuities and promissory notes. Revised to include 2010 penalty rates January 15, 2010.
15 Jan, 2010
533 kb
Downloads: 58558
Form MAP-751D - Authorization for Disclosure of Individual Health Information
MAP-751D HRA HIPAA Release.pdf
Use this form to enable NYC HRA to disclose protected health information to another party (such as an authorized representative). This is the HIPAA release used by the Medicaid program in NYC. Rev. 7/4/03.
5 Nov, 2010
289 kb
Downloads: 54572
Medicaid Spend-Down - PowerPoint Presentation
Spend-down presentation - 2017 corrected.pptx
This PowerPoint presentation explains the rules, also see the Training Outline on Medicaid Spend-down posted on this site (revised 2017).
31 Oct, 2017
1.27 mb
Downloads: 54336
Medicaid Household Size Chart for Aged, Blind and Disabled Individuals ("SSI-Related")
HOUSEHOLD SIZE FOR SSI RELATED CHART 2026.pdf
Updated 2026. Rules for determining when a married applicant can use the income limit for TWO people -- which is higher than the limit for ONE person.
19 Feb, 2026
142 kb
Downloads: 53557
Medicaid Resource Disregards
ResourceDisregards.pdf
This table lists all of the types of resources (aka, assets) that are excluded for purposes of Medicaid eligibility, including which Medicaid categories they apply to, and citations to authority.
Do not use for MAGI Medicaid effective 1/1/2014. Updated 10/7/2013.
7 Oct, 2013
66 kb
Downloads: 52650
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