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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Confused about MLTC & FIDA? 
Come to a Live Training Session for Professionals 

December 3, 2014
1:00 - 5:00 PM (LIVE AND Webinar)


Sponsored by:  NYLAG and New York Chapter of Professional Geriatric Care Managers 

American Jewish Committee
165 East 65th Street, NYC, NY
  

Webinar option available for remote viewing.

CLE credit available 
 4.5 NASW CEUs
Fee will be charged. 

Trainer:  Valerie Bogart.  

Download announcement and registration form here, including scholarship request information.

David Silva Leaving the Evelyn Frank Legal Resources Program at NYLAG 

We sadly announce the departure of David Silva from the Evelyn Frank Legal Resources Program.  Effective November 17th, David will be moving to the Community Services Society to lead the new statewide Ombudsprogram for the new FIDA Demonstration and MLTC - called "ICAN" (Independent Community Advocacy Network).  Fortunately, we can look forward to continuing to collaborate with David and with ICAN, since EFLRP/NYLAG will be one of the partner organizations in the ICAN network helping dual eligibles navigate the new FIDA demonstration program and MLTC. Stay tuned for contact information.  

David came to EFLRP when it was at Selfhelp Community Services, Inc. at the time that Medicare Part D was launched in 2006.  He has helped thousands of people - from vulnerable seniors and people with disabilities who needed his strong advocacy, to social workers and lawyers needing to tap his deep and expansive knowledge of the complex public health insurance programs that so many depend on.  Anyone who has been to his trainings or sought his advice knows how generous he has always been with his time and expertise.  We are thrilled, however, that the Ombudsprogram will have a strong leader to ensure that it protects the rights of the most vulnerable New Yorkers.  We give heartfelt thanks to David for his many years mentoring so many colleagues and helping so many New Yorkers -- and wish him all the best in his new venture.  

For a sample of  the dozens of engaging trainings David has conducted, view his 2013 free training on using pooled trusts and SNT's to eliminate the Medicaid spend-down here!  

Good news about “Spousal Impoverishment” Protections

In response to advocacy by the NYS Bar Association Elder Law Section, on November 3, 2014 the NYS Dept. of  Health issued yet another directive on the new Spousal Impoverishment protections as they apply to married persons enrolled in Managed Long Term Care programs.

GIS 14 MA/025 - Spousal Impoverishment Budgeting with Post-Eligibility Rules Under the Affordable Care Act  (PDF), dated Nov. 3, 2014, rescinds an earlier  NYS DOH GIS 14 MA/015, issued August 5, 2014, and reinstates two even earlier directives.   Pending further clarification from the federal CMS, "districts are to resume applying the policy provided in  GIS 12 MA/013 and NYS DOH GIS 13 MA/018,. . .These GIS messages provide for spousal impoverishment budgeting with post-eligibility rules only when it is more advantageous to the applicant." 

The effect of reinstating these earlier GIS messages is to allow married MLTC participants to continue using pooled trusts (or individual supplemental needs trusts) if it is more advantageous than using spousal impoverishment protections. 

This change is made pending further clarification of CMS, so is not the last word.  It is a reprieve, however, for many Suffolk County residents who were already rebudgeted with large spend-downs after the County banned them from using pooled trusts.  Read more here.

For those who DO want the spousal impoverishment protections - unfortunately, the initial Medicaid budget will not include them.  You have to apply first using regular community budgeting - which may have a large spend-down.  Using spousal refusal may help reduce the spend-down, but not if the APPLICANT SPOUSE's income is high.  But - as soon as client is enrolled in an MLTC plan, you can ask the local Medicaid program to revise the budget with the spousal impoverishment protections  - used in "Post-Eligibility Budgeting."   In many cases this will reduce or even eliminate the spenddown because the APPLICANT SPOUSE's income can be allocated to the community spouse's income, to bring the community spouse's  income up to $2,931/month.  

NYC HRA Terminates Medicaid for 2500 SSI Recipients In Error -


By a NYC Medicaid Alert released September 26, 2014, NYC HRA Medicaid program announced that approximately 2,500 consumers in NYC eligible for  SSI benefits were incorrectly identified for closing of their Medicaid cases as of 10/31/14. These consumers were sent a Stenson renewal notice.   Read about the Stenson process here.  HRA stated that all 2,500 notices should be corrected.  Read more here.   
 

Conflict-Free Eligibility  Assessment Before Enrolling in an MLTC Plan Expanded to all of NEW YORK CITY and NASSAU November 1st  (CFEEC)

Anyone seeking to enroll in a Managed Long Term Care after November 1st in New York City and Nassau County will need to first contact NEW YORK MEDICAID CHOICE and request a CFEEC assessment.  Manhattan and the Bronx started in October, and the rest of NYC and Nassau on Nov. 1st.   If that assessment conducted by a nurse in the client's home, hospital or nursing home, finds the person eligible for MLTC, then the person can enroll in an MLTC plan - if they have active Medicaid.  You MUST already have approved Medicaid to enroll in an MLTC plan.

SEE NEW YORK MEDICAID CHOICE WEBSITE ON CFEEC 
TEL:  1-855-222-8350

NEXT COUNTIES STARTING the assessment centers --
  • Region 3 – February 2015: Westchester & Suffolk
  • Click here for FAQ with schedule for rest of state and other information.  Also see NYHealthaccess.org.
Will this delay enrollment into MLTC?  Probably.  MLTC plans may not accept an enrollment without confirmation from CFEEC that you are MLTC-eligible.  That confirmation is valid for 60  days.   The State FAQ (Q13) says the CFEEC assessment can be done while Medicaid application is pending, but since a Medicaid application can take more than 60 days - it can be risky.  It is also unclear whether the consumer must only sign an MLTC plan enrollment form within 60 days of the CFEEC assessment, or must actually be enrolled in the plan by that date - the difference can be significant.

Social Security Administration Revises Procedures Manual to Clarify that the "Ghetto Pension" does not Count as Income or Assets for SSI 

 The Social Security Administration updated its online Program & Operations Manual (POMS) in TWO WAYS to ensure that the GHETTO PENSION or ZRBG does not reduce SSI or Social Security:
Contact EFLRP at 212-613-7310 or EFLRP@nylag.org 

Copyright © 2014 New York Legal Assistance Group, All rights reserved.



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