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NYC HRA Medicaid Form MAP-3062a Request for a Time Extension (12/5/17)(fillable) Download
MAP-3062a Request for a Time Extension (12-5-17) Fillable.pdf
Used for applications, renewals, and the new requirement to apply for Medicare for those age 65+. "I am unable to provide the documentation that HRA requested at this time. I am requesting additional time past the deferral due date that HRA provided. I understand that this extra time may delay the final processing of my case which could result in an eligibility determination taking longer than the normal case processing timeframe of 30 days for a case containing a child, 45 days for a case containing adults only, or 90 days for a case based on a disability." Asks to specify if this is initial extension request or later. This is a fill-in-able form.
11 Jan, 2018 66 kb Downloads: 141
SNT Outline for Advocates Download
SNT Outline 2018 01-03-2018.pdf
Training Outline for Advocates on Supplemental Needs Trusts (SNTs) (including individual and pooled), and the affect of SNTs on various public benefit programs. (updated 1-2018). Update includes new section on ABLE accounts as alternative to SNTs.
03 Jan, 2018 1.08 mb Downloads: 160821
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2017 Download
2001_to_2017_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2017. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
03 Jan, 2018 3.14 mb Downloads: 251179
Medicaid income and resource levels - 2018 Download
2017-12-29 2018 NYS Medicaid Income and Resource Standards.pdf
NYC HRA Form MAPDR-01
2018 NYS Income and Resource Standards and Federal Poverty Levels (FPL)
Dated 12/28/2017. Still has 2017 Federal Poverty Levels for MAGI limits, MBI-WPD, MSP, etc. until 2018 levels are announced in April 2018
03 Jan, 2018 195 kb Downloads: 308021
Nassau County Physician's Request for Personal Care Aide and Orders to the Service Agency (May-2016) Download
Physician's Nassau Request for Personal Care Aide Form 517 (Rev. 05-16).pdf
Form for doctor to complete to request Medicaid personal care services and CDPAP from the Nassau County DSS. Revised May 2016.
02 Jan, 2018 218 kb Downloads: 3279
Most downloaded
Medicaid income and resource levels - 2018 Download
2017-12-29 2018 NYS Medicaid Income and Resource Standards.pdf
NYC HRA Form MAPDR-01
2018 NYS Income and Resource Standards and Federal Poverty Levels (FPL)
Dated 12/28/2017. Still has 2017 Federal Poverty Levels for MAGI limits, MBI-WPD, MSP, etc. until 2018 levels are announced in April 2018
03 Jan, 2018 195 kb Downloads: 308021
NYS Medicaid Income and Resource Levels for Past Years - 2001 - 2017 Download
2001_to_2017_NYS_income__resource_level_charts.pdf
Income and Resource levels for Medicaid and other public health programs in NYS for 2001 - 2017. Includes Medicare Savings Programs, Family Health Plus, Child Health Plus, Spousal Impoverishment levels, MBI-WPD, etc.
03 Jan, 2018 3.14 mb Downloads: 251179
Medicaid Eligibility in 2014 Download
Understanding MAGI & the Marketplace.pdf
Training provides framework for understanding the changes to Medicaid effective 2014, including: new categories, new income levels, new budgeting and new benefits.
15 Nov, 2013 1.56 mb Downloads: 201870
Directory of MICSA (NYC Medicaid) Contacts - August 2013 Download
MICSA Directory (08-06-13).pdf
NYC Medicaid office moved from 330 West 34th Street to 785 Atlantic Avenue, Brooklyn NY 11238 in May 2013. Contact numbers at that office listed in this document.
15 Aug, 2013 3.07 mb Downloads: 193392
Medicaid Spend-Down Training Outline Download
spendownOUTLINE09.pdf
Comprehensive outline published by Selfhelp, covering the many strategies for obtaining Medicaid coverage in New York through the Excess Income Program. Updated 5/29/09.
19 Jul, 2010 279 kb Downloads: 168796

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