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Income and Resource Limits for New York State Public Health Insurance Programs
INTRODUCTION AND NEWS ALERTS Feb. 13, 2026 UPDATE - NYS DOH announced the 2026 limits are in effect for Medicaid GIS 26 MA/05 - 2026 Federal Poverty Levels (PDF) GIS 26 MA/05 - 2026 Federal Poverty Levels Chart Since Jan. 1, 2023, the income limit for the Aged, Blind and...
Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
Introduction and links to info about transition to the new NYS "Single Fiscal Intermediary" (FI) This article for latest news including settlement of Calderon lawsuit PPL - the Single Fiscal Intermediary for CDPAP in NYS - Nuts & Bolts includes registration, timekeeping, requirements...
Medicaid Personal Care or Home Attendant Services
INTRO and RECENT UPDATES 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...
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...
Medicare Savings Programs (MSP) in New York
Introduction 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...
Previous Medicaid Dental Benefit in NYS (Rules Effective for Services Requested Through 1/30/24)
New York’s Medicaid program includes limited dental benefits. The coverage was expanded beginning on January 31, 2024 as the result of the settlement of the Ciaramella v. McDonald case (originally Ciaramella v. Zucker). This article explains Medicaid dental rules in effect until January 31,...
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...
Medicaid Spend-Down
Because Medicaid is a health insurance program for the poor, one must have income and assets below a certain limit to be eligible. For a single elderly or disabled person in New York State in 2026, the income limit is $1836/mo. of income. (after subtracting $20/mo disregard) (The income limits for...
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 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...
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...
Medicaid for Immigrants who are Not Permanent Residents (Do Not have "Green Cards")-- PRUCOL and Temporary Non-Immigrant Eligibility
New York State Medicaid covers many immigrants not covered by federal law. Since 1996, federal Medicaid limits Medicaid eligibility to US citizens and “Qualified Aliens,” which include: Lawful Permanent Residents (LPR or “green card”) – under federal law, all but pregnant women &...
Medicaid Certified Home Health Agency (CHHA) Services
A Certified Home Health Agency (CHHA) provides what is commonly known as “visiting nurse” services, as well as physical or occupational or speech therapy (PT/OT) in the home, "home health aide" (HHA) services, and medical supplies. The nursing visits are "part-time or intermittent " and NOT...
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 Reimbursement of Home Care and other Medical Expenses
Reimbursement in General Because Medicaid coverage can be retroactive up to three months, it is possible for a Medicaid applicant or his or her family member who paid the applicant's medical expenses to get reimbursed for some of the home care costs and other medical bills they incurred and paid...
NYS Medicaid Application Form and "Supplement A" for Age 65+ or Disabled or Blind
Since 2010, the New York State Department of Health Medicaid application form is called the Access NY Application or Health Insurance Application or form DOH-4220 - available at this link. (As of 2-06-25 the form was last updated in January 2023.) See GIS 23 MA/17 - Revised DOH-4220: Access NY...
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 -...
Medicaid 1915(c) Home-and-Community-Based Services (HCBS) Waiver Programs in New York State
News Alerts Jan. 26, 2026 ALERT: The NHTD HCBS Waiver enrollment cap has been reached, so the waiver is now full. The DOH NHTD waiver website states "Because we have reached the approved maximum number of participants, we cannot process any additional referrals to the Nursing Home Transition and...
Family Health Care Decisions Act
New York’s Family Health Care Decisions Act (FHCDA)(Chapter 8 of the Laws of 2010, adding Public Health Law Ch. 29-CC and 29-CCC) allows a patient’s family member or close friend to make health care decisions for a patient who is in a hospital or nursing home, or to decisions regarding hospice...
Spousal Impoverishment Protections for Married Couples - If One Spouse is in MLTC, Waiver or Immediate Need - Can use Pooled Trust
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...
Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA)
August 5, 2024 - address for main NYC Medicaid Office - called the Brooklyn South Medicaid office - has been changed to 495 Clermont Avenue, Brooklyn, NY 11238. This is around the corner from the previous address on Atlantic Avenue since 2013 see 2024-08-02 Change of address for Brooklyn_South...
Emergency Medicaid in New York State - Limited Medicaid Coverage for Undocumented Immigrants & Changes for Age 65+
News and Updates 2026 Update - See the 2026 State directive applying to those under age 65 with Emergency Medicaid who have not used Medicaid for more than six months. GOOD NEWS ALERT: January 1, 2024 - Undocumented immigrants age 65+ became eligible for full Medicaid (as opposed to only...
Applying for Medicaid Personal Care or CDPAP Services in New York City - 2021-2022 Changes
May 16, 2022 Update - The new NY Independent Assessor (NYIA) starts being phased in. See info about that huge change in this article. Starting May 16, 2022 the M11q is no longer required for people applying to HRA for Medicaid home care who are NOT seeking MLTC because they are exempt or excluded...
Medicaid Renewals/Recertifications in NYC- Medicaid can be DISCONTINUED if RENEWAL not returned - Starting April 2025
INTRODUCTION and NEWS UPDATES This article explains the annual procedure to RENEW MEDICAID for people whose Medicaid is administered by the NYC Human Resources Administration (HRA). For those living in different NYS counties outside NYC, whose Medicaid is administered by the Local Department of...
Keeping Medicaid after Cash Public Assistance or SSI Benefits Are Terminated
Scenarios: Susie is 49 years old and single, with no children. She has been receiving cash public assistance and Medicaid for three years, while she appeals the denial of Social Security Disability Insurance Benefits ("SSD" or "DIB"). She finally was approved for SSD, and will start receiving...
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