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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...
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...
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 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 -...
Restricted Recipients
MEDICAID MANAGED CARE FACT SHEET Restricted Recipients- the way you receive your Medicaid benefits is changing! On August 1, 2011, Medicaid recipients who are restricted to certain providers will have to enroll in a Medicaid health plan. Before August 1, 2011, restricted recipients were...
What You Need to Know about NYRx (Medicaid Pharmacy Program)
By the Legal Aid Society This guide will answer common questions about New York State’s new Medicaid pharmacy benefits program, NYRx, which took effect April 1st, 2023. How does NYRx work? Through NYRx, New York State Medicaid will now pay for your drugs and medical supplies when you are at...
Court Orders Lifting Restrictions in Medicaid Coverage for Compression Stockings and Orthopedic Footwear
Federal Court Orders State to Stop Restricting Coverage of Compression Stockings and Orthopedic Footwear. On July 1, 2016, a federal judge in New York issued an order enjoining state health officials from limiting coverage of orthopedic footwear and compression stockings for some state Medicaid...
Delays in Processing of Medicaid Applications - What are Your Rights and Lawsuits Challenging Delays
The Deadlines to Process Medicaid Applications in the Law Federal and state law set time limits for processing a Medicaid application. The federal Medicaid Act requires eligibility to be determined with "reasonable promptness." A determination of eligibility for Medicaid must generally be made...
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...
"Ensure" and Enteral Nutritional Supplements - When does Medicaid Pay for it? 2013 Changes for Adults
Children under 21 are entitled to obtain "Ensure" or other nutritional supplements when medically necessary. However, the State has enacted laws in the last few years that restrict eligibility for nutritional supplements for adults age 21+. In 2011, the state budget law limited these "enteral...
Physical, Speech & Occupational Therapy Limits Lifted for 2021
The 2011-12 NY State budget, ] limited access to compression stockings, prescription footwear, and enteral nutritional formula, as well as physical therapy, occupational therapy, and speech therapy. Some of these limits have been repealed or made less harsh. Physical, Speech, and Occupational...
New York Dramatically Expands Mandatory Managed Care for Medicaid Beneficiaries (2012)
Many people who used to be exempt from mandatory enrollment in Medicaid managed care have been receiving notices in summer and fall 2012 telling them that their exemption has ended, and that they now have 30 days to enroll in a managed care plan. This type of managed care is sometimes called...
Fundamental Changes to NY Medicaid in the 2011 State Budget
The Health Budget passed this week makes fundamental and far-reaching changes to New York’s Medicaid program, with savings reported at $2.8 billion. The proposals that were presented to the legislature in the Governor’s 30 day amendments represented a package submitted by the Medicaid Redesign...
Know Your Rights: NYLAG Trainings on Medicare, Medicaid, and Home Care
The Evelyn Frank Legal Resources Program (EFLRP) regularly hosts trainings (via webinars and other presentations) that provide tools for the public to understand and navigate the complex world of Medicare and Medicaid in New York. Some of these trainings are via the NYLAG webinar account, and...
NYS Medicaid Codes - What do they Mean?
This article has links to references for various codes for Medicaid eligibility and billing. 1. ELIGIBILITY CODES When you prepare for a fair hearing and obtain an evidence packet, and in some other instances, you obtain screenshots from the eMedNY system - the computer system that stores...
When Documentation of Resources and Income is Required for Medicaid Applications & Renewals - and When is "Attestation" Enough?
Since 2004, Medicaid documentation requirements have been simplified by allowing some applicants merely to "attest" rather than document certain eligibility factors. In that year, attestation to the amount of one's resources was first allowed for Medicaid applicants who were not seeking Medicaid...
Medicaid Alerts & Other Protocols published by the NYC HRA Medicaid Program
HRA Medicaid Alerts are periodic announcements of policy, staff and office changes published by the HRA Medicaid Progarm (MAP) (formerly called the "Medical Insurance and Community Services Administration (MICSA)". The Medicaid Program is the part of New York City’s Human Resource Administration...
Financial maintenance requirements at application and renewal
In September, 2011, NYS Department of Health (DOH) clarified the administrative directive 10ADM-06 Standardized Financial Maintenance Requirements for Medicaid Applicants/Recipients, which in June, 2010, established a standardized methodology by which local social services districts and...
Medicaid Resource and Income Disregards
When determining eligibility for Medicaid in New York state, the local district determines the gross income and resources of the applicant, and then deducts certain items which may be disregarded. If any of these disregards apply to a particular applicant, then they may be eligible for Medicaid...
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...
What You Need to Know About Lump Sum Payments and Medicaid Eligibility
By the Legal Aid Society Introduction Information about receiving a lump sum payment from Medicaid and how it may affect your eligibility or coverage. If I receive a lump sum payment, like a court settlement, workers’ compensation payment, or inheritance, will it affect my Medicaid coverage? ...
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...
Elimination of resource test for adults in Family Health Plus and many adults in Medicaid
Beginning January 1, 2010 the resource test for all adults in Family Health Plus and many adults in Medicaid is eliminated. There is no resource test for Medicaid recipients who are Singles/Chlldless Couples (S/CC)(over age 21 and under age 65 and not disabled and not caring for children...
The Medicaid Buy-In for Working People With Disabilities (MBI-WPD)
The Medicaid Buy-in for Working People with Disabilities (MBI-WPD) expands eligibility for individuals with disabilities under age 65 who have work income. Under MBI-WPD, individuals are eligible for full Medicaid benefits at much higher incomes than individuals who are not working. The income...
Advocacy to Improve the Medicaid Spend-down Program in New York State
In May 2009, the New York State Health Foundation issued a report titled Streamlining New York's Excess Income Program, written by Manatt Health Solutions. The report presents a clear picture of the daunting complexity of the Excess Income or “spend-down” program. This program makes Medicaid...
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