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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...
Early and Periodic Screening, Diagnostic and Treatment (EPSDT)
Note: For a quick introduction to EPSDT, see the attached powerpoint titled "NYLAG Presentation on EPSDT." Please feel free to share those slides, as well as the material below, widely. In this article: Part 1 - Basics about EPSDT Requirements Part 2 - Select Services that Must be Covered...
KNOW YOUR RIGHTS: Managed Long Term Care - Fact Sheets, Live and Recorded Webinars
A. Recent and Upcoming Presentations and Recorded Webinars Download Powerpoint presented at the Elder Law Forum on May 14, 2026 - Presenter Valerie Bogart Topics include: 1. 30-month Financial Lookback for Home Care Eligibility Status 2. The Strict ADL Thresholds for NEW...
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...
Special Medicaid Income Rules That May Eliminate Your "Spend-down" or "Surplus Income"
Many people age 65+, Disabled or Blind would normally have an income "spend-down" because their income is above the non-MAGI limits (which are in BOX 1 of the HRA Income & Resources chart ). This Fact Sheet explains the basic rules of Non-MAGI Budgeting used for people age 65+, Disabled, or...
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...
PPL- Wages & Benefits for CDPAP Personal Assistants - OPEN ENROLLMENT 4/15/26 - 5/15/26
Introduction and NEWS ALERTS ALERT: PA's who wish to change Health Insurance plans or enroll in one for the first time MUST ENROLL BY MAY 15th. Those who were in the high-deductible SecureHealth bronze plan may want to change to the lower-deductible SecureHealth Plus silver plan. See more here. ...
Temporary Protected Status (TPS) and Public Health Insurance
THE TRUMP ADMINISTRATION HAS ended Temporary Protected Status (TPS) for many countries, but there are some court injunctions extending TPS. See the USCIS website to see updates for particular countries and some information below. Also see this chart which is frequently updated TPS: Quick...
"Immediate Need" Fast-Track Application for Medicaid and Personal Care or CDPAP - Choices for those with full Medicaid start April 2024
Introduction and News Alerts Medicaid has a fast-track procedure to apply for Medicaid in order to obtain home care services, which has been faster than enrolling in a managed long term care plan. Click here to learn about the reasons for MLTC enrollment delays. The 2015 New York law requires...
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...
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...
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...
Medicaid for Undocumented Immigrants Age 65+ - Starts January 2024
INTRODUCTION June Starting Jan. 1, 2024, immigrants age 65+ can get FULL MEDICAID even if they do not qualify for PRUCOL status (PRUCOL is discussed in this article). This include most services - including home care, prescription drugs, and Nursing Home care. See more below about services...
Medicaid Fair Hearings in NYS - Common Links and Changes
Introduction and Updates 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 ("LDSS") or by NYS's contractor, NY Medicaid Choice or the NY...
Can My MLTC Plan Kick Me Out? "Involuntary Disenrollment" from MLTC plans - Changes start June 1, 2026
A. Introduction and Updates 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...
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...
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...
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...
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...
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...
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