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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EFLRP Winter Newsletter -- and --
Please support us this year and your gift will be matched!

Please help us meet a generous matching grant of $20,000 from FJC - A Foundation of Philanthropic Funds -- and support the work of the Evelyn Frank Legal Resources Program (EFLRP) at the New York Legal Assistance Group (NYLAG). If you've learned from one of our seminars or updates on, or if we've counseled you on how to help your clients, patients or family -- we need your support to help the most vulnerable seniors and people with disabilities. Here's just one example of how we help: 
  • Joshua, a 93-year old Holocaust survivor living in Washington Heights, was stymied for nearly a year trying to enroll in a managed long term care plan. His social worker from a non-profit organization had applied for Medicaid for him in June 2014. Even after Medicaid was finally approved, by March 2015 he was still not enrolled - and she contacted EFLRP for help. Our legal team broke through the bureaucratic barriers to get him enrolled in a plan within a month.  
  • In addition to individual representation, we attack the problems that caused the delays for Joshua by:
    • Legislative and policy advocacy.  See this article, which includes links to comments filed by NYLAG in October 2015 on proposed state procedures that will expedite authorization of home care for new Medicaid recipients.
    • Training thousands of professionals on how to navigate daunting systems. See this Fact Sheet and others posted here, and our running news updates on MLTC and FIDA -- and much more on
We need your help so that we can continue our advocacy!

Click here to make a donation online. Be sure to select Evelyn Frank program in the “Select a Unit” dropdown menu.  

Or send a check payable to "New York Legal Assistance Group" earmarked for EFLRP to:
NYLAG - Development Dept.
7 Hanover Square, 18th floor,
New York, NY 10004 

Thank you for your support!

State Reforms FIDA to Address Low Enrollment; Suffolk & Westchester Delayed Until Mid-2016  

In December 2015, the NYS Department of Health (DOH) and the Centers for Medicare and Medicaid Services (CMS) announced that they have reformed the FIDA program, "with specific attention to improved flexibility for Participants, Plans, and providers."  Read about changes in the "Inter-Disciplinary Care Team" (IDT), marketing and enrollment, and other changes in this article    The primary changes are described in this NYS Dept. of Health Summary of FIDA Reforms  and a 12/22/15 webinar presentation by NYS DOH. All of these links are posted on the DOH MRT 101 FIDA webpage.    

How to Obtain Medicaid Home Care Quickly - When There is an "Immediate Need" for Services

In July 2015, the NYS Dept. of Health issued the GIS 15 MA/011 - Reminder of Expedited Authorization Process for Medicaid Recipients with Immediate Need for Personal Care Services. This directive makes an important change for any adult who has Medicare who needs Medicaid home care.
  • Before this directive was issued, the "front door" was closed to apply for Medicaid personal care services from the local Medicaid agency (HRA Home Care Services Program in NYC). Anyone who had Medicare had to apply for Medicaid at the local Medicaid agency, but then had to enroll in a Managed Long Term Care plan to get home care. This can cause big delays, described more here.
  • With this directive, the local Medicaid office must authorize personal care services if Medicaid has already been approved, and if there is an immediate need for these services.  To request these services, submit a physician's order - known as an M11q in New York City (click here for a fill-able version).  Also see Q-Tips for tips on how the physician can complete the M11q.
TIP: Though the local Medicaid agency will only process a request for expedited home care once Medicaid is approved, you may submit the physician's order/ M11q along with the Medicaid application. Include a cover letter that requests that the Medicaid application be expedited and explain why there is an immediate need for services and why the applicant cannot wait to enroll in an MLTC plan. For more information, read this article.

MLTC Now Mandatory Statewide; some plans drop out

  • In July 2015, the last upstate counties began "mandatory" enrollment in Managed Long Term Care for adult Medicare beneficiaries needing long term home care. These counties are Allegany, Clinton, Franklin, Jefferson, Lewis, and St. Lawrence. All other counties became mandatory earlier.  This means that, with few exceptions, any adult in NYS with Medicare must access Medicaid home care through a Managed Long Term care plan.
  • Two plans have pulled out of the MLTC market:
    • HIP/EmblemHealth MLTC plan -- the 5th smallest plan in NYC -- sent letters to its 1300 members on November 25, 2015 that it would no longer offer MLTC coverage as of January 1, 2015. Unless members choose and enroll in another MLTC plan by December 18th, they will automatically be enrolled in Guildnet.
    • Homefirst MLTC - in September 2015, this plan discontinued enrolling new members in eight upstate counties --Albany, Erie, Niagara, Monroe, Onondaga, Rensselaer, Saratoga, and Schenectady. Members were notified that they could switch to another plan, but could remain in Homefirst if they did nothing.

Click here to see past issues of NYLAG EFLRP Newsletter

Our whole team at EFLRP wishes you and your loved ones a happy and healthy new year - and thanks you for your support. 

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