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  • In-kind income
    When a person or organization pays an expense on someone's behalf, rather than giving them cash, this is considered in-kind income.  For example, if a family member pays your phone bill, then it is in-kind income; but if they write you a check so that you can pay your phone bill, it is cash income.  In-kind income is usually not counted for purposes of Medicaid eligibility.  However, see Medicaid Reference Guide, Income, at 106-108.1.
  • Look-back period
    The length of the period for which asset documentation is required when applying for Medicaid coverage of nursing home care.  For nursing home Medicaid applications between now and February 2011, the look-back period extends back to February 1, 2006.  From February 2011 onward, the look-back period will be 60 months long.  Medicaid will impose a transfer penalty based on the amount of uncompensated transfers identified within the look-back period.
  • LRR
    Legally Responsible Relative - For purposes of Medicaid eligibility, "[a] relative who, by law, is responsible for the support and care of another person. In New York State, spouses are responsible for each other and parents are responsible for their children under 21."  See Medicaid Reference Guide, Glossary, at xi.
  • LTC
    Long-Term Care - health-related services provided to a person with disabilities that assist that person in completing activities of daily living and/or maintaining maximum functioning.  Includes both community-based long-term care (see CBLTC) and facility-based (e.g., nursing home, assisted living residence).
  • LTHHCP
    Long Term Home Health Care Program - AKA Lombardi waiver or nursing home without walls.  A Medicaid wavier program which provides a nursing home alternative to patients requiring that level of care. It includes coverage of case management by registered nurses, home delivered meals, home improvements, respiratory therapy, medical, social, nutritional and dietary services, and respite care. See DOH website on LTHHCP.
  • MAGI
    MAGI is one of the two types of categories of Medicaid (the other being Non-MAGI Medicaid). MAGI Medicaid is for New Yorkers who are not aged (65+), Blind with Medicare, or Disabled with Medicare. More specifically, MAGI Medicaid includes pregnant people, dependent children under age 19, parents/caretaker relative of children under age 19, and singles/childless couples ages 19 through 64 who are not entitled to or enroll in Medicare. Note: An applicant 65+, or an applicant with Medicare, is typically considered non-MAGI Medicaid, but if this person is a parent/caretaker relative of at least one child under age 19, they may choose to be classified as MAGI or non-MAGI.
  • Managed care
    A type of private health insurance product that typically has the following features:
    • Capitation - the plan is paid a fixed amount per member per month by the payor (e.g., employer, union, Medicare, Medicaid) to provide a defined package of covered services.  The plan's reimbursement does not vary based upon the amount or cost of medical care provided.
    • Network - generally members of a managed care plan can only receive coverage for services provided by medical providers who have agreed in advance to participate in the plan's provider network, and thereby receive a contracted rate of payment.
    • Utilization Management - the plan may impose restrictions on coverage of certain procedures, such as requiring the physician to obtain permission from the plan before performing them, or limiting the number of pills that can be prescribed.  Some plans require members to have a primary care physician (PCP), and require the PCP to give referrals to any specialists before their services will be covered.  Occasionally, managed care plans go further and proactively coordinate care among the member's providers.
  • MAP
    Medicaid Advantage Plus - This is a type of managed care plan that includes virtually all services covered under Medicare and Medicaid.  It is like a Medicare Advantage plan merged with a Medicaid managed care plan and an MLTC plan.  It covers everything included in Medicaid Advantage, plus all MLTC services.  This is one option for dual eligibles who are in need of LTC services and thereby required to enroll in MLTC (the other two are partial-cap MLTC and PACE).  Otherwise, it is voluntary.
    The acronym MAP is also used to refer to the Medical Assistance Program in New York (in other words, Medicaid).
  • MBI-WPD
    Medicaid Buy-In for Working People with Disabilities - A special Medicaid benefit that has a much higher income limit for people with disabilities who are working.  See DOH MBI-WPD website.
  • MECM Assistor / MECM Certified Assistor
    MECM Assistor or MECM Certified Assistor: These are the official umbrella terms for helpers for any type of MECM insurance (right now: non-MAGI Medicaid and MSP, but eventually this list will be broadened). These terms encompass, as of August 2026, only FE-ABDs since no one else has been offered the training yet. But in the future, these terms will also include people from the LDSS's who have completed the training, HIICAP counselors who have completed the training, Navigators and CACs who have completed the training, and possibly others.
  • Medicaid

    Medicaid is the public health insurance program for people of limited means. It is jointly funded by the Federal, state, and local governments. However, each state has its own Medicaid program, which completely different rules regarding eligibility and what services are covered. You should assume that any information provided on this website only applies to the New York State Medicaid program (also known as "Medical Assistance").

  • Medicaid Advantage
    A type of private managed care plan that is a combination of a Medicare Advantage plan and a Medicaid managed care plan.  These plans cover all services under Medicare Parts A, B, & D, as well as almost all services covered under Fee-For-Service Medicaid in New York, with the exception of personal care, CDPAP, mental health, and adult day health care.  This type of plan is always optional.  It may make sense for dual eligibles who do not require long-term care services.
  • Medicaid Eligibility and Client Management system (MECM)
    The Medicaid Eligibility and Client Management system ("MECM"), which began in New York in September 2025, is a third Medicaid eligibility system in New York. MECM exists online, built into the NYSOH system. While the first wave of cases on MECM (for 2025-2026) included only select types of non-MAGI cases, Medicare Savings Program (MSP) cases, Low Income Subsidy cases, and Presumptive Eligibility for Pregnant Individuals cases, the ultimate goal of New York State is for all cases held in the WMS eligibility system at the Local Departments of Social Services/Human Resources Administration to be moved into the MECM system.
  • Medical home
    A model of care that gives each patient a more personal and continuous relationship with their physician(s). This can include round the clock access to medical consultations, more comprehensive care coordination, and providing both care and health education in a way that respects the patient’s beliefs and cultural background.
  • Medically needy
    A federal category of Medicaid eligibility for people who are unable to afford their medical bills but have income and resource levels too high for traditional Medicaid. They may "spend down" their excess income and resources on medical bills to qualify for Medicaid.  They must not be currently receiving any public cash assistance  benefits, such as SSI or public assistance.  Only certain "categories" of individuals are medically needy:  DAB category (Disabled/Aged 65+/ Blind), and AFDC category (children under age 21,  their parents or other relatives who live with them, and pregnant women).
  • Medicare Advantage
    A voluntary, optional program where Medicare beneficiaries may choose to enroll in a private managed care plan to receive their Medicare health insurance.  These plans must cover all services provided under Medicare Parts A and B (and often D), except for hospice.  Although they must cover the same services to roughly the same extent, there is considerable variation among plans in out-of-pocket costs, and unlike Original Medicare, members are generally limited to providers in the plan's network and subject to utilization management.  Medicare Advantage plans may cover a few extra services not otherwise covered by Medicare (e.g., limited dental, limited vision, gym membership), and they may be a good option for beneficiaries who cannot afford the cost of supplemental Medigap policies, yet whose income is too high for Medicaid (which itself acts as a supplement to Medicare).  To compare Medicare Advantage plans, see http://medicare.gov/find-a-plan.
  • MICSA
    Medical Insurance and Community Services Administration - A division of New York City's Human Resources Administration that includes Adult Protective Services, the HIV/AIDS Services Administration, the Medical Assistance Program, and the Home Care Services Program.  This is the agency that administers the Medicaid, Family Health Plus, and Child Health Plus programs in New York City.
  • MLTC
    Managed Long-Term Care - in the general sense, refers to any type of private managed care organization in New York State whose benefit package includes Medicaid long-term care services (such as home care, adult day care, and nursing home).  Currently, this general category includes Partially-Capitated MLTC plans as well as fully-capitated ones such as MAP and PACE.  The term MLTC is more often used specifically to refer to the partially-capitated type of plan.  These plans do not include any Medicare-covered services, nor do they include all services covered under Medicaid.  Members of these plans must use them to access all types of home care, nursing home care, adult day care, medical transportation, podiatry, audiology, optometry, and dentistry.  All other services are covered either by Medicare or Fee-For-Service Medicaid.  Since 2012, it has been mandatory for dual eligibles needing Community-Based Long-Term Care services to enroll in MLTC, MAP or PACE plans in order to receive them.  See http://www.wnylc.com/health/entry/114/.
  • NHTD Waiver
    Nursing Home Transition and Diversion Waiver - This is one of New York's four 1915(c) Home and Community Based Services waivers, also called HCBS waivers. The NHTD waiver which is designed to help transition nursing home residents back to the community, and to divert nursing home-eligible individuals from institutional placement, by providing a comprehensive package of long-term care services in the community.  NY Soc. Serv. L. § 366(6-a).
  • Non-MAGI
    Non-MAGI is one of the two types of categories of Medicaid (the other being MAGI Medicaid). Non-MAGI Medicaid is for New Yorkers who are aged (65+), Blind with Medicare, or Disabled with Medicare. For this reason, Non-MAGI Medicaid is sometimes called "Aged, Blind, Disabled" Medicaid or "ABD" Medicaid. Note: An applicant 65+, or an applicant with Medicare, is typically considered non-MAGI Medicaid, but if this person is a parent/caretaker relative of at least one child under age 19, they may choose to be classified as MAGI or non-MAGI.
  • NYSOH
    New York State of Health, also known as NYSOH, the Exchange, and the Health Benefit Exchange ("HBE"), is the state's second Medicaid eligibility system, and the statewide ACA online marketplace. Individuals, families, and small businesses can use NYSOH to shop for, compare, and purchase health insurance. Options for health insurance on NYSOH include: Child Health Plus, MAGI Medicaid, Essential Plan/Basic Health Plan, and Qualified Health Plans with  or without Advanced Premium Tax Credits.
  • NYSOH Appeals Unit
    NYSOH Appeals Unit: This is the unit that processes, hears, and issues decisions on appeals related to eligibility for any type of insurance offered on NYSOH or on MECM. For more information on NYSOH Appeals, including how to contact the NYSOH Appeals Unit, see the NYSOH FAQ page: Questions about Appeals. 
  • NYSOH Assistor
    NYSOH Assistor: This is the official umbrella term for the helpers for any type of NYSOH insurance (MAGI Medicaid, Child Health Plus, Essential Health Plan/Basic Health Plan, and Qualified Health Plan with APTCs). This term encompasses Navigators, CACs, and Marketplace Facilitated enrollers (who work for health plans).
  • OMH
    Office of Mental Health - The state agency that provides services for people with mental disabilities.
  • OPWDD
    Office for People With Developmental Disabilities - The state agency that provides services for people with mental retardation and developmental disabilities.  This agency also administers the Medicaid Waiver program for people with Intellectual and Developmental Disabilities. Formerly known as the Office of Mental Retardation and Developmental Disabilities (OMRDD).
  • OPWDD Waiver
    Office for People With Developmental Disabilities Waiver - This is one of New York's four 1915(c) Home and Community Based Services waivers, also called HCBS waivers. The OPWDD waiver is run by the OPWDD state agency.
  • OTDA
    New York State Office of Temporary and Disability Assistance - (Pronounced "Oh-ta-Da")  This is the New York State agency that administers Temporary Assistance (aka "welfare" or "public assistance"), Food Stamps, HEAP, and other programs.  OTDA also conducts all Fair Hearings in New York State, including Medicaid Fair Hearings.  See OTDA website.
  • PACE
    Program of All-inclusive Care for the Elderly - A PACE is a type of fully-capitated MLTC plan that provides a comprehensive system of health care services for members age 55 and older who are otherwise eligible for nursing home admission. Both Medicare and Medicaid pay for PACE services (on a capitated basis).  PACE members are required to use physicians & providers employed by or contracted with their plan.  An interdisciplinary team develops care plans and provides on-going care management. The PACE is responsible for directly providing or arranging all primary, inpatient hospital and long-term care services required by a PACE member.  Most participants are dually eligible for Medicare and Medicaid, with a small number in only one or the other.
     
  • Parental refusal
    Ordinarily, when a minor child applies for Medicaid, the income and resources of their parents are counted, because parents are Legally Responsible Relatives for their minor children.  However, a child may prevent their parents' income/resources from being counted if the parent signs a statement indicating their refusal to make their income/resources available for the child's medical care.  This is called a parental refusal.
  • Pay-in program
    When a patient pre-pays their spend-down to the Medicaid agency to activate their Medicaid coverage, instead of incurring medical bills to offset their excess income.

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