Evelyn Frank Legal Resources Program
January 2021 Update

We in the Evelyn Frank Legal Resources Program (EFLRP) wish all of our supporters a happy and healthy new year, with hopes for success in navigating the challenges of this difficult time.

Below is the latest on Medicaid changes:

2. New “Lookback” for Community-Based Long-Term Care Delayed Until at Least April 1, 2021, No Date Set for Other Changes
3. More MLTC members who have been in a nursing home for 3 or more months will be disenrolled from MLTC plans on April 1st if they were approved for Nursing Home Medicaid
4. NEW MLTC "LOCK-IN Rule" Started December 1, 2020
5. 2021 Medicaid Income Limits announced; Medicaid Cannot be Reduced or Stopped During COVID Emergency
1. New “Supplement A” Required for All Medicaid Applications in New York City for Age 65+ or Disabled; Must be Signed by Spouse 

On December 22, 2020, the NYC Medicaid program issued a Medicaid Alert, “Asset Verification System Expanded to all DAB/SSI Related Submissions.” HRA really buried the lead in this Alert. While the expansion of the Asset Verification System (“AVS”) to Community Medicaid applications has been a long time coming, of more consequence for anyone who assists seniors or people with disabilities in filing Medicaid applications in NYC are changes in the Supplement A form that must accompany the main application, which is Form DOH-4220. These changes began on January 1st.

  1. A different "Supplement A" form must now be used -- form DOH-5178A - the same form that has long been used outside of NYC. DO NOT USE Form DOH-4495A, which has been used in NYC until now.
  2. The Supplement A form must now be submitted with ALL Medicaid applications. Before, it was only required if you were seeking home care, managed long term care enrollment, the Assisted Living Program, or other community based long term care services. See more about this change here. It is not required if only seeking a Medicare Savings Program.
  3. The Supplement A form must be signed by the SPOUSE, even if the spouse is doing a spousal refusal or is not applying for Medicaid. This is also a big change.
See more about these changes and why they are being made in this article, which also explains what happens if the old Supplement A form (or no Supplement A) is sent with the application, and has links to the new form in languages other than English.
2. New “Lookback” for Community-Based Long-Term Care Delayed Until at Least April 1, 2021; No Date Set for Other Home Care Changes 
As previously reported, the NYS Budget enacted earlier in 2020 will require a “lookback” for new Medicaid applications seeking community-based long term care services. This means the application must include bank statements and other financial documents for a “lookback” period, which will eventually be 30 months. This new requirement has been delayed at least until April 1, 2021. New applications filed after that date must include all financial documents back to Oct. 1, 2020. Initially, the lookback will be six months, then an extra month will be added until it is thirty months in April 2023. The Department of Health has not released details on how this major change will be implemented. It may be delayed further. To find out more and check for updates, visit this webpage. The State budget also enacts other changes in how personal care and Consumer-Directed services are assessed and approved. No specific date has been set for these changes to begin. Read about these changes and check for updates here.
3. More MLTC members who have been in a nursing home for 3 or more months will be disenrolled from MLTC plans on April 1st if they were approved for Nursing Home Medicaid 
Despite being in the middle of a pandemic that has prevented family members from visiting their loved ones in nursing homes to help them appeal disenrollment notices, the State Dept. of Health ignored pleas by NYLAG and other advocates and has moved forward with a series of mass disenrollments of over 20,000 members from MLTC plans since August 2020. More were disenrolled on January 1st and more will be disenrolled on April 1, 2021. MLTC members who have been approved for institutional Medicaid and have been in a nursing home for three or more months will receive disenrollment notices in January, which explain fair hearing rights and the right to call NY Medicaid Choice to request an assessment by the MLTC plan to authorize home care services needed for possible discharge home. Advocates have asked that copies of the notices be sent to residents’ designated family members, since many residents lack the ability to respond to them, or may not receive them at all. However, this is not being done.

See these advocacy tips for helping a consumer who is temporarily in a nursing home to remain in their MLTC plan and return home with home care services. 
4. NEW MLTC "LOCK-IN Rule" Started December 1, 2020 
Anyone who enrolls in an MLTC plan beginning December 1, 2020, whether new to the MLTC program or changing plans on or after that date, will be “locked-in” and unable to change plans unless they have good cause, after the first 90 days in the plan. Read more about this new lock-in rule here.
5. 2021 Medicaid Income Limits announced – Medicaid Cannot be Reduced or Stopped During COVID Emergency 
The State Dept. of Health announced the 2021 Medicaid income and resource levels for the Aged (65+), Blind & Disabled, also known as the “Non-MAGI.” See GIS 20-MA-13 posted here. Usually, all Medicaid recipients are automatically re-budgeted each year, which may result in an increased spend-down because of the cost-of-living increase in Social Security and other income. However, the State directive says that this “systematic update” will not run because of the “Maintenance of Effort” requirement in the Families First Coronavirus Protection Act, which forbids any reduction or termination of Medicaid during the Public Health Emergency (PHE). An increase in the spend-down would be a reduction of Medicaid. The Public Health Emergency was just extended by HHS effective Jan. 21, 2021, for three months, so will end April 21, 2021, unless extended further. Therefore, Medicaid should not be terminated, and the spend-down should not be increased, until then. See more about COVID and Medicaid here.

POOLED TRUST TIP: Though the spend-down cannot be increased based on increased income during the Public Health Emergency, NYLAG still recommends that clients using Pooled Income Trusts increase their trust contribution in 2021 to offset the anticipated increased spend-down. Submit verification of the increased deposit to your local Medicaid program with a request to budget the increased deposit. In NYC, fax this documentation to HRA Medicaid Undercare at 917-639-0837 or the spend-down program at 917-639-0645. 
Make a note on the submission if the consumer receives home care or is in an MLTC plan or ALP, so that it is routed to the Home Care Services Program. HRA will soon be releasing a new form to request re-budgeting for pooled trusts or for other reasons (many described in this article). This form will be posted here and here when available.
Thank You for Your Support of NYLAG's Evelyn Frank Legal Resources Program – It’s Not Too Late to Help!
Thanks to many of you who generously contributed to our end of the year fundraising campaign. If you have not yet given, during these hard times, we need your support more than ever. If you can, please donate generously to support NYLAG's Evelyn Frank Legal Resources Program with a check or an online donation today.
Checks can be made payable to "NYLAG." Please put "EFLRP" or "Evelyn Frank" in the memo line or in a cover note and send them to:

New York Legal Assistance Group
Attn: Helen Murphy
100 Pearl Street, 19th floor New York,
NY 10004

Your donations assist us in helping thousands of seniors and people with disabilities who depend on an advocate to access Medicaid services and the long-term care needed for them to stay safe in their homes. It also enables us to continue sharing this relevant and timely information with you, so you are informed in real-time of the changes that affect our communities and loved ones.

Thank you for standing with us. We very much appreciate your support and wish you and your loved ones well.
To see our past newsletters, please click this link.
To sign up to receive this newsletter, please click this link (check "Medicaid and long-term care"). 

Valerie Bogart 
Director, NYLAG’s Evelyn Frank Legal Resources Program
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