Greetings – Here are some Medicaid updates from the Evelyn Frank Legal Resources Program, with links for where to find more information.
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Good News for Medicaid in N.Y. State Budget

Good news for Medicaid recipients in the State Budget for 2014-15 just enacted on March 31, 2014.  Read more about these three victories in the final budget – and others – here:
  • Keeps Spousal Refusal intact, along with “parental refusal” for children;
  • Ensures “Aid Continuing” for Managed Long Term Care (MLTC) and other Medicaid managed care recipients when they appeal a reduction or even termination of their home care services by an MLTC or managed care plan,
  • Limits liens on the Estates of people who received “MAGI” Medicaid – meaning they do not have Medicare and applied for Medicaid on NY State of Health Exchange
Help for seniors other than in Medicaid -- Increases Income Limits for SCRIE Rent Increase Exemption and for EPIC Prescription Drug Subsidy

Big thanks are due to NYS Assembly Health Committee Chair Richard Gottfried for his creative leadership and persistence on these issues!

Expansion of Mandatory Managed Care and MLTC to Include Nursing Home Residents

Still awaiting CMS approval, NYS has now delayed until June 1, 2014 the new requirement that mainstream Medicaid managed care plans as well as MLTC plans must now provide nursing home services, and that people who become permanent residents in nursing homes after June 1, 2014 will have to join a managed care or MLTC plan.  This will start in NYC, Long Island and Westchester in June 2014 and then expand upstate in December 2014. 

Fully Integrated Dual Advantage (FIDA) Demonstration program Delayed Until January 1, 2015

This demo has been delayed until January 2015 but voluntary enrollment will start earlier in October 2014.  All MLTC and nursing home residents who have Medicaid and Medicare in NYC, Long Island and Westchester will receive notices telling them they may join a FIDA plan.. with the right to “opt out” if they don’t want to join. If they don’t opt out in 60 days, they will be automatically assigned to a plan.  These plans will be like Medicaid Advantage Plus (MAP) plans – they will control and authorize all Medicare and Medicaid services.   Read more about it here

Two Developments in “Spousal Impoverishment” Protections

HRA Corrects Illegal Practice of Denying "Spousal Impoverishment" Income Allowance to Some Spouses of Nursing Home Residents - see this article   - Thanks to advocacy by the NYS Bar Association Elder Law Section, over 600 spouses of nursing home residents in NYC had their “spousal impoverishment” monthly income allowance reinstated.  The NYC Medicaid program had improperly stopped budgeting these allowances if the community spouse had done a “spousal refusal.”  Many individuals had won hearings against this practice, but when the Bar Association advocated, HRA changed its practice retroactively.

Any married MLTC recipient in NY State may now be budgeted to have the same spousal impoverishment protections that used to exist in the Lombardi program, and that are used in nursing home budgeting.  See more in this article.   

MLTC Schedule for Expanding to Upstate Counties – and other MLTC Updates

Medicaid home care contact lists in NYC

For those who help people apply for Medicaid home care in NYC, it can be hard to find out who to call when there’s a problem with the application, or with a pooled trust, or with enrolling in an MLTC plan. 
Copyright © 2014 New York Legal Assistance Group, All rights reserved.

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