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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...
The Minimum ADL Test to Qualify for MLTC, CDPAP or Personal Care - Starting Sept. 1, 2025
Starting September 1, 2025, ADULT Medicaid recipients age 21 and over who are newly applying for Personal care services ["PCS"], Consumer-Directed Personal Assistance (CDPAP), or Managed Long Term Care (MLTC) or Medicaid Advantage Plus (MAP) enrollment must meet a higher eligibility test to...
NEW YORK INDEPENDENT ASSESSOR PROGRAM (NYIAP) - How Medicaid Home Care Eligibility is Assessed
IN THIS ARTICLE: What is the Independent Assessor? Click here for the basics. Two Official Websites about NYIA When does NYIA Start? Contacts - Where to Submit Complaints, How to Request an Evidence Packet, How to Submit a Power of Attorney NYIA CONSENT FORM - Where to...
CDPAP: April 2025 Transition to PPL as Single Fiscal Intermediary - Background, Press & Archive
Background. The 2024-25 NYS Budget required all 280,000 Medicaid recipients who have CDPAP services to switch their "Fiscal Intermediary" (FI") the agency that manages payroll and benefits for their Personal Assistants ("PA") to a new "single FI" called Public Partnerships LLC or "PPL." FI's have...
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...
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...
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...
Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes start Nov. 1, 2024
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...
Medicaid Fair Hearings in NYS - Common Links and Changes
Medicaid recipients have the right to request a Fair Hearing to appeal an adverse action. This includes decisions made by a managed care or Managed Long Term Care plan, by the local Dept. of Social Services, or by NYS's contractor, NY Medicaid Choice or the NY Independent Assessor. This is not...
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 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...
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...
NYS Essential Plan - ACTION ALERT! Call to Keep Coverage - when Income Limit reduced to 200% from 250% Federal Poverty Level on July 1, 2026
JULY 1, 2026 CHANGES - 450,000 People Will be Kicked Off Essential Plan because Income Limits will be Reduced Starting July 1, 2026, the NYS Essential Plan (EP) will have REDUCED eligibility levels - cutting eligibility from 250% of the Federal Poverty Level to 200% FPL. This reverses the...
2025 Medicaid Modernization in New York State: Medicaid Eligibility and Client Management System (MECM)
For a background document comparing MAGI Medicaid, Non-MAGI Medicaid, and the Medicare Savings Program, click here. For an example MECM notice showing Medicaid and MSP eligibility, click here. For an example MECM notice showing Medicaid and MSP ineligibility, click here. For the YouTube recording...
Appeals & Grievances in Managed Long Term Care & Managed Care
Since May 1, 2018 - Member Must Request Internal "Plan Appeal" before requesting a Fair Hearing In 2016, CMS adopted changes in federal Medicaid managed care regulations requiring "exhaustion" of Plan Appeals prior to requesting a Fair Hearing. These changes became effective in NYS in MAY 2018. ...
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...
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...
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...
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...
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....
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...
ARCHIVE: US Lawsuit Against NYC for "False Claims" - Says HRA Wrongly Approved 24-Hour Medicaid Home Care
Amicus (Friend of the Court) Brief Filed by Consumer Advocates Disputing Allegations of Fraud in NYC Home Care Program On August 12, 2011, Selfhelp Community Services, New York Lawyers for the Public Interest, Legal Services-NYC, and Cardozo Bet Tzedek Legal Services led 41 organizations in...
About Us
This site is made possible in part by grants from the New York State Office for Aging and the New York Community Trust. We are also grateful to Western New York Law Center for hosting the site until early 2026. We are grateful to Selfhelp Community Services, which housed the Evelyn Frank Legal...
Useful Websites and Phone Numbers
FEDERAL WEBSITES - government Centers for Medicare and Medicaid Services (CMS) (Federal agency which oversees Medicare and Medicaid programs) also www.medicare.gov HealthCare.gov is a Federal government website in Spanish to provide consumers with both public and private health coverage...
Medicare Insurance Premium Payment Program (MIPP)
Some "dual eligible" beneficiaries (people who have Medicare and Medicaid) are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program (MIPP). The Part B premium is $202.90 in 2026. MIPP is for some groups who...
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