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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Happy Holidays and Wishes for a Peaceful New Year 

As 2014 draws to a close, this newsletter provides important information about the new "FIDA" program being launched in New York City and Nassau County.

We in the Evelyn Frank Legal Resources Program wish a happy holiday to all of our supporters and all of those who work hard to enable older people and people with disabilities to live independently in their communities.  We appreciate all of the support from our friends in elder law, social work, home care, and geriatric care management, and salute all of the families struggling to help their loved ones. 

As we close out the year, please donate to support us at  this webpage and select the Evelyn Frank program in the “Select a Unit” dropdown box.    

FIDA Launches with Mailing to MLTC Members in NYC and Nassau County & NYC - Clearing up Confusion

More than 100,000 people enrolled in Managed Long Term Care plans in New York City and Nassau County have received the State's first "FIDA Announcement letter" - mailed in the last week in November and the first two weeks in December 2014. Unfortunately, the letter comes on the heels of the short annual Open Enrollment period for Medicare Advantage plans and Part D - in which Medicare beneficiaries were inundated with marketing mail. As a result, many of these letters may have been tossed in the garbage, as they could appear to be yet another piece of marketing mail. Read this article, to learn what this letter means. Read about  what important information is left out -- such as the right to opt out of FIDA, Learn some helpful tips to help clients decide whether to enroll in FIDA. 

Here are other helpful tools:
  • list of FIDA plans showing which MLTC plans have an affiliated FIDA plan and in which counties in the FIDA demonstration area (NYC, Long Island and Westchester). 
  • A  FIDA Fact  Sheet oriented to family caregivers to help them help their loved ones make decisions about FIDA. 
  • A different FIDA Fact Sheet for advocates
To OPT OUT of FIDA call NY Medicaid Choice 1-855-600-FIDA  (1-855-600-3432) Monday to Friday 8:30 am to 8:00 pm and Saturday from 10:00 am to 6:00 pm. TTY: 1-888-329-1541 Website: 

Read more here - and for more background on FIDA click here.

CORRECTION:  Phone number for ICAN - State OmbudsProgram

Our last newsletter had an incorrect phone number for ICAN - the Independent Consumer Advocacy Network, the Ombudsprogram for people who are enrolled in NYS managed care plans and who receive long-term care services. Call 1-844-614-8800  Monday-Friday, 8:00 am – 8:00 pm Website: E-mail:  ICAN is a program of the Community Services Society, funded by the NYS Dept. of Health.

Revised M11q Form Causes Confusion in New York City 

This month, NYC HRA issued a revised M11q Form - the Physician's Order form used to apply for Medicaid personal care (a/k/a home attendant), housekeeping services, or consumer-directed personal assistance program (CDPAP) services.  The new form - still called the M11q - is HCSP-M11q (Dec. 9, 2014) and was issued along with tips for completing the form (part of the same document).
  • The form has caused confusion because the M11q is no longer used for most applicants for personal care in NYC.  Most adults who have Medicare and Medicaid (dual eligibles) are required to enroll in Managed Long Term Care (MLTC) plans to receive personal care or CDPAP services.  These plans do not require or use the M11q form. 
  • Dual eligibles in New York City seeking MLTC services still must apply for Medicaid through the NYC HRA Home Care Services Program, but no longer need to submit the M11q.  After their Medicaid is approved, they contact NY Medicaid Choice for a Conflict-Free Eligibility and Enrollment assessment (1-855-222-8350), and then enroll directly in an MLTC plan.

Medicaid applications (not M11q) for people seeking MLTC should be filed at  HRA--HCSP Central Medicaid Unit 

785 Atlantic Avenue, 7th Floor

Brooklyn, NY 11238                              T: 929-221-0849

Who does still need to submit an M11q to HRA Home Care Services Program to apply for personal care, Consumer-Directed Personal Assistance, or Housekeeping?
  • HOSPICE - Dual eligibles (people with Medicare and Medicaid) who have Hospice services - are not eligible for MLTC so apply for personal care at HRA Home Care Services Program.
  • HOUSEKEEPING - Dual Eligibles who need only HOUSEKEEPING services, limited to only 8 hours per week - these are people who do not need an aide for personal care (dressing, bathing, ambulation) - only for housekeeping (laundry, cleaning, shopping, meal preparation) as a result of disability
  • Dual Eligibles under age 21 who need home care
  • People with Medicaid only, who do not have Medicare, who are not enrolled in a "mainstream" Medicaid managed care plan.  If they are enrolled in such a plan, they should submit an M11q directly to their plan and request the plan to approve home care.  
  • People enrolled in an OPWDD waiver or the Traumatic Brain Injury (TBI) waiver apply for personal care services through HRA.   
Medicaid applications (and the M11q) for people seeking home care who are not eligible for MLTC -- as listed above --should be filed at:
NYC HRA Home Care Services Program
          109 East 16th Street, 5th Floor,
          New York, NY 10003                                TEL 212-824-0706   FAX 212-896-8814 

TIP 1:  For those who still must file an M11q, use these Q-Tips as a guide to helping the doctor complete the form. 

TIP 2:  For those who DON'T need to file an M11q, use the M11q and Q-Tips as a guide for the treating physician to write a statement that lists the individual's diagnoses, medications, need for assistance of an aide, and impairments that impact the ability to perform daily activities.   Provide a copy of this statement to the assessor doing the Conflict-Free Eligibility and Enrollment assessment and also to the MLTC plan at the time of enrollment. 
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