What Is The Look Back Period
New York has a 60-month “look back” period for Medicaid applicants seeking nursing home care. Officials will review the applicant’s financial transactions for 60 months before the application date, checking whether any assets were sold or given away for less than fair market value.
The “look back” was created to discourage applicants from simply giving their possessions and cash to friends and family to qualify for Medicaid. If any transfers violate the fair market value rule, the applicant will endure a penalty period of Medicaid ineligibility.
What If I’m Over The Financial Limit
If your available resources are too high to qualify for Medicaid, you have a few options. The first is to pay for nursing home costs out of your own pocket, exhausting your assets until you become eligible for benefits. Unfortunately, many people will do just that because they aren’t aware of better alternatives.
Our Medicaid and life care planning attorneys can help you qualify for benefits without sacrificing everything you’ve worked hard for over the years. Depending on your circumstances, we may be able to secure your benefits through:
Are Medicaid And Medicare The Same Thing
No. Medicaid is a needs-based program primarily used to pay for long-term care, whether in a nursing home or through New York’s Home and Community-Based Services program.
Medicare is a government-sponsored healthcare insurance program that covers adults over 65 and people with severe disabilities. While it covers regular doctors’ visits, emergency treatment, and prescriptions, it won’t provide enough to cover the full costs of long-term nursing care.
Don’t Miss: Residential Treatment Centers That Accept Medicaid
Medicaid Buy In Program For Working People With Disabilities And Medicare Savings Programs
The Medicaid Buy-In Program for Working People with Disabilities provides Medicaid coverage for people ages 16-64 who have a disability and are engaged in a work activity for which they are paid. In order to be considered for this program, the individual must be determined disabled as defined by the Social Security Administration. The persons net income must be at or below 250% of the federal poverty level.
Get Important News & Updates
Sign up for email and/or text notices of Medicaid and other FSSA news, reminders, and other important information. When registering your email, check the category on the drop-down list to receive notices of Medicaid updates check other areas of interest on the drop-down list to receive notices for other types of FSSA updates.
Also Check: Drug Rehabs In Ohio That Take Medicaid
You May Like: Pregnancy Medicaid Texas Phone Number
Medicaid Transportation Nyc & Ny
The New York State Medicaid program provides both emergency and non-emergency medical transportation to beneficiaries. The transportation program is managed by two different companies: Medical Answering Services and LogistiCare Solutions. The program includes coverage for public transportation, personal vehicles, taxis, wheelchair vans, ambulances, and even commercial airlines when necessary.
We Also Encourage You To Download Our Take On Obtaining Medicaid For Home Care:
Please Note: Information provided herein is for convenience purposes. Nothing on this page or website constitutes legal advice, and we recommend that you verify all information on your own and seek legal counsel where appropriate. Please see full disclaimer at the bottom of this page.
When it comes to Medicaid in NY State, the first thing that one needs to determine is the applicants budgeting category. People in different age groups and circumstances are subject to different eligibility rules, and the services available in each category may also vary. In this section we will be discussing eligibility and services for the aged, blind, and disabled. This category includes people who are 65 and above, certified blind by the Commission for the Blind and Visually Handicapped, and certified disabled by Social Security or NY State . There are three levels of Medicaid for this category:
- Community Medicaid
Get help applying for Medicaid for home care
What is Covered by Community Medicaid?
While Medicaid covers prescription drugs, people with Medicare will not have their prescription drugs paid for by Medicaid directly. Rather, Medicaid will pay Medicare to provide a free Medicare Part D prescription drug plan for these beneficiaries. Click here to learn more about this.
Community Medicaid with Long-Term Care provides everything that Community Medicaid does with the addition of community based long-term care services such as home care, adult day care, and assisted living .
You May Like: Florida Medicaid Waiver For Developmental Disability
Frequently Asked Questions For Current Medicaid Beneficiaries
What is a Community Spouse?
A community spouse is someone whose husband/wife is currently institutionalized or living in a nursing home. The community spouse is not currently living in a nursing home and usually resides at the couple´s home.
I am a community spouse. Will I be allowed to keep any income or resources?
If your spouse is institutionalized or living in a nursing home, you will be permitted to keep some income known as a minimum monthly maintenance needs allowance . If you are currently receiving income in excess of the minimum monthly maintenance needs allowance, you may be asked to contribute twenty-five percent of the excess income to the cost of care for the institution
How do I find my local Medicaid office?
The Medicaid office is located in your local department of social services. A listing of offices can be located here:
If you live in the five boroughs of New York City, your offices are run by the Human Resources Administration . A listing of offices can be found here:
How do I order a new benefit card?
If your Medicaid is with your LDSS, to order a new Medicaid Benefit Identification Card, please call or visit your
If your Medicaid is with the and you need to order a new benefit card please call the call center at 1-855-355-5777.
Members residing in the five boroughs of NYC can call the HRA Infoline at 1 557-1399 or the HRA Medicaid Helpline at 1 692-6116.
How often do I have to renew?
How Common Are Medicaid Denials And How Do I Appeal One
On Behalf of Angiuli & Gentile, LLP | Nov 21, 2022 | Elder Law
If you recently received a denial on your application for New York Medicaid benefits, you probably have a lot of questions.
A Medicaid denial is a nerve-wracking experience, especially when you are not sure why you received it in the first place. Here are some potential reasons why Medicaid denied you and what you can do about it.
Also Check: At What Age Can You Qualify For Medicaid
Who Is Eligible For Medicaid In Florida
The following people may qualify for Florida Medicaid if they meet certain financialrequirements:
- Infants and children under the age of 21
- Recipients of Supplemental Security Income
- Seniors who are aged 65 or older
- People who are blind or expected to be disabled for at least a year
- People who need nursing home care or home and community-based care
- Medicare Beneficiaries whose income is low
- Aliens and refugees under a special assistance program
- Individuals who are medically needy
- Through your Local Department of Social Services Office
Where you apply for Medicaid will depend on your category of eligibility. Certain applicants may apply through NY State of Health while others may need to apply through their Local Department of Social Service . No matter where you start, representatives will help make sure you are able to apply in the correct location. For more information on determining your category of eligibility and where you should apply read on.
NY State of Health determines eligibility using Modified Adjusted Gross Income Rules. In general, income is counted with the same rules as the Internal Revenue Service with minor variations. Individuals who are part of the MAGI eligibility groups listed below should apply with NY State of Health.
- Adults 19-64 years of age and not eligible for Medicare,
- Children 1 18 years of age
- Pregnant Individuals,
- Parents and Caretaker Relatives of any age
Other factors that may affect your eligibility include:
- State Residency
Supplement A
Establishing A Need For Services
Third, although persons over the age of sixty-five are presumptively disabled for the purpose of Medicaid eligibility, the applicants must show that they require assistance with their activities of daily living . Some examples of activities of daily living include dressing, bathing, toileting, ambulating and feeding. Community Medicaid will not provide care services where the only need is supervisory therefore, it is important to establish an assistive need with the tasks listed above. For some clients, this is not a difficult threshold to reach. However, for many of our clients, when we first inquire as to whether the individual in need of care requires assistance with these tasks the answer is no. However, after further discussions it becomes clear that they do in fact require assistance with many of these activities. This discrepancy lies in the fact that in order to establish need, the applicants need only show that they are unable to complete these tasks unassisted. It is not necessary that there be a showing that they are unable to manage any part of the task, only that they need some level of help.
Recommended Reading: How Can You Qualify For Medicaid
If You Qualify Under A Non
- If you are a U.S. citizen and provide a valid Social Security Number , a match with the Social Security Administration will verify your SSN, date of birth and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need to submit proof of naturalization or a U.S. passport.
- Proof of citizenship or immigration status*
- Proof of age , like a birth certificate
- Four weeks of recent paycheck stubs
- Proof of your income from sources like Social Security, Veteran´s Benefits , retirement benefits, Unemployment Insurance Benefits , Child Support payments
- If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information on bank accounts, insurance policies and other resources
- Proof of where you live, such as a rent receipt, landlord statement, mortgage statement, or envelope from mail you received recently
- Insurance benefit card or the policy
- Medicare Benefit Card **
Proof of Medicare application can be:
- Your award or denial letter from the Social Security Administration, OR
- Your on-line confirmation letter stating that you have applied for Medicare with the Social Security Administration.
Apply Now:
How To Apply For Mississippi Medicaid Health Benefits
Online
Mississippis Common Web Portal at Access.ms.gov is a convenient way to apply for children, pregnant women, low-income parents of children under age 18 and anyone else who needs to apply. Documents can be uploaded and sent electronically with your application to the Medicaid Regional Office serving your county of residence. Medicaid Specialists in the Regional Office check available electronic sources to verify as much information as possible and then follow-up if additional information is needed. NOTE: If you want to apply for Medicaid due to age, blindness or disability on Access.ms.gov, be sure to check YES to a limiting or disabling condition when those questions appear in the application flow. This lets us know you are asking for a Medicaid decision that considers age, blindness or disability as a condition of your eligibility.
The Mississippi Division of Medicaid and the federally facilitated marketplace has one single application for all insurance affordability programs. Application for any of the insurance affordability programs may be filed online through Access.ms.gov or the FFM at Healthcare.gov. If you apply through Healthcare.gov, the FFM will assess your potential eligibility for Medicaid or CHIP and then return your application to the Division of Medicaid for the final eligibility decision.
To fill out this application, you will need:
Don’t Miss: Doctors In San Antonio That Accept Medicaid
Does Medicaid Cost Me Anything
Some services may include a small copay, such as clinic visits, laboratory tests, medical supplies, overnight hospital stays, emergency room visits for nonâemergency services, prescription drugs, and over the counter drugs.
Certain people are exempt from copays entirely, including anyone who opts for a Managed Care Plan. Talk to your caseworker for more details about copays specific to you.
There is an annual limit of $200 for out of pocket copayments, after which you will not need to pay any more copays that year. No provider can refuse treatment for inability to pay and must bill you for unpaid copays if needed.
Use The Ny Medicaid Doctors List
The best way to find a doctor in your area who accepts New York Medicaid plans is to use a provider search tool like ZocDoc. You can search by location, name, condition, procedure, or the type of doctor you are looking for. You can also use the official NYS Provider and Health Plan lookup tool to search by health plan, provider, or facility.Back to Top
Don’t Miss: Can A Student Get Medicaid
How To Check The Status Of A Medicaid Application
You can check your Medicaid application status through your program office. Insurance representatives can review your claim and see whether a decision has been reached regarding your case. If you applied online, you may also be able to check the status of a Medicaid application by going to the same portal you applied through.
Effective Date Of Coverage
Once an individual is determined eligible for Medicaid, coverage is effective either on the date of application or the first day of the month of application. Benefits also may be covered retroactively for up to three months prior to the month of application, if the individual would have been eligible during that period had he or she applied. Coverage generally stops at the end of the month in which a person no longer meets the requirements for eligibility.
Also Check: Does Medicaid Cover Abortions In Virginia
How Do I Appeal A Denial
If you want to appeal your Medicaid denial, you should identify whether it came from a local office or the New York State of Health. You can submit an appeal for a fair hearing online, over the phone, via fax or in writing, but you need to request the hearing within 60 days of receiving your denial notice. At the hearing, you must present evidence to support why you think your application deserves approval. An administrative law judge will hear your argument and approve or deny your appeal.
A Medicaid denial is discouraging, but do not lose hope. You can appeal the decision if you believe your application denial was an error.
Income Requirements For New York Medicaid
The income requirements for Medicaid are based on various resource levels for the state. For example, the income requirements for people who are over the age of 65, blind, or otherwise disabled are different than they are for people who are single or who are married but without any children. Additionally, assets are to be accounted for. When it comes to getting around the Medicaid financial requirements, you can only have more money if you are over 65, a child, pregnant, blind, or otherwise disabled.
In general, you can only have income that is not over 138% of the FPL for your size family or household. If you would like to see specifics as far as what you can earn for your household size, click here.
Also Check: How Much Does Medicaid Pay For Aba Therapy
Medicaid Renewals/recertifications In New York City
This article available as a fact sheet in ENGLISH and SPANISH
This article is for people whose Medicaid is administered by the NYC Medicaid program, run by the Human Resources Administration . If your Medicaid is handled by the New York State of Health your renewal is not covered in this article. The process is different outside NYC, though the general principles are the same.
Medicaid is authorized for one year at a time. Approximately 3 4 months before the end of your authorization period, you should receive a renewal packet by mail, which includes instructions on how to complete and return the packet to HRA. This process is also called recertification. Here are tips for handling renewals, including how to obtain a copy of the renewal form if you dont receive one in the mail.
Whilemost counties in NYS stopped sending the renewal requests entirely, NYC HRA has still sent out the renewal packets as usual. But but even if the consumers don’t return it, the Medicaid office MUST recertify Medicaid coverage for 12 months.
See this article for all COVID-19 flexibilities and updates.
Nys Medicaid Otc Formulary And Prescription Drug Coverage
The NYS Medicaid formulary is very comprehensive the PDF is 659 pages long! NYS Medicaid providers are expected to select the cheapest option of any drug they prescribe to a New York Medicaid beneficiary. In most cases, this means that the generic form of the drug will be selected. If you notice that your doctor prescribes a brand-name drug, ask and make sure that it is the most affordable option. NYS Medicaid may cover brand-name drugs as well, but generic options are almost always cheaper. Generic drugs usually provide the same benefits as their brand-name counterparts.
In some cases, New York Medicaid may provide reimbursements for over-the-counter products as well. To get that reimbursement, your doctor will need to provide a fiscal order, which is sort of like a prescription for over-the-counter drugs and products.
Recommended Reading: Dentist In Montgomery Al That Accept Medicaid
No Cost Sharing For Covid
Medicaid must cover, without any cost-sharing expenses, the following: COVID-19 testing, testing-related services, and COVID-19 related treatment for Medicaid enrollees, which include vaccines, specialized equipment and therapies.
Effective December 13, 2021, Medicaid, is also covering over-the-counter FDA-approved at-home rapid antigen tests. This applies to both fee-for-service Medicaid, as well as to Medicaid managed care plans. Covered test kits must be authorized for use in both symptomatic and asymptomatic patients and allow for self-collection without medical observation. Pharmacists can order the at-home kits for the patients.
