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Letter to OTDA Commissioner with Recommendations to Improve Fair Hearing Demonstration Project

Posted on September 14th, 2022

Empire Justice Center, The Center for Elder Law & Justice, New York Legal Assistance Group, Neighborhood Legal Services, Legal Aid Society of New York City, & Bronx Legal Services submitted a Letter to Commissioner Daniel W. Tietz with recommendations to improve the Fair Housing Demonstration Project on June 14, 2022.

 

Read the letter below or download PDF HERE.

VIA EMAIL on June 14, 2022
Daniel W. Tietz, Commissioner
New York State Office of Temporary and Disability Assistance
40 North Pearl Street, Albany, New York 12243

 

Re: Recommendations to Improve the Fair Hearing Demonstration Project

 

Dear Commissioner Tietz:

Thank you for meeting with us on March 30 to discuss OTDA’s remote fair hearing Demonstration project and the concerns and suggestions we sent in August 2021 and in our January 25, 2022 correspondence. Thank you also for sending the documents on April 13. As you requested, we write to provide a summary of our specific recommendations thus far.

 

Notices

Attached please find proposed edits to the notices listed below. We recommend that OTDA review all notices for reading level and edit the notices to be in plain language as much as possible. We did not make this change in the attached documents but we also ask that all notices be in an accessible format such as 14 font size and 1.15 spacing, using a sans serif format.1

  1. Fair Hearing Request Form – Fax or Mail
  2. Acknowledgment of Fair Hearing Request and Confirmation of Aid Status Notice
  3. Notice of Fair Hearing – We recommend creating two notices: one for a telephone hearing, and one for an in-person hearing.
  4. Notice of Telephone Hearing

 

Model Opening Statement

Attached please find our proposed edits to the model opening statement for telephone hearings.

 

Other Recommendations

  1. Increase capacity for the phone lines to ensure that callers more consistently reach staff and staff process hearing and aid continuing requests timely
  2. Train staff at the call center and all staff that process fair hearing requests.2
  3. Promptly clear the backlog of delayed fair hearings. Issue all decisions within 90 days of the fair hearing request3 or within 60 days of a SNAP fair hearing request.4
  4. Waive overpayments.
    1. In any fair hearing where aid continuing has been granted and the decision issued is not favorable to the appellant, the recovery of all aid continuing shall be waived if the fair hearing decision was issued more than 90 days from the date of a fair hearing request or more than 60 days from the date of a SNAP fair hearing request.
    2. In accordance with recent Food and Nutrition Service (FNS) guidance5:
      i. submit a waiver request to FNS to administratively waive pandemic-period agency error or inadvertent household error overpayments (including pandemic-period claims previously adjudicated);
      ii. revise the claims threshold for pandemic-caused over-issuances where the claims are not waived entirely;
      iii. fully implement the regulatory authority to terminate and write off claims for pandemic-period over-issuances; and
      iv. fully implement the regulatory authority to compromise unwaived claims based on financial hardship.
  5.  Create an affirmative opt-in to telephonic hearing for all hearing requests.a. Appellants who request a hearing by phone should be asked for their hearing venue preference (i.e., in person, telephone, video).
    b. Add an option to the online form to allow Appellants to select which hearing venue (i.e., in person, telephone, video) they prefer.
    c. Refer to our attached edits to the Fair Hearing Request Form – Fax or Mail.
  6. Implement a system that allows all ALJs to securely send, receive, exchange, and otherwise share documents in real-time with appearing parties for all phone and video hearings.
  7. Reissue 20 GIS TA/DC 097 and remind ALJs of the requirement that they must transmit Appellants’ documentary evidence to the Agency via encrypted email during the hearing. Also remind ALJs that it is not the responsibility of the Appellant to supply the Agency’s evidence packet to the ALJ.
  8. Add the option for a video hearing as allowed under OAH Transmittal 20-05/20 TA/DC097, dated October 16, 2020.
    1. Provide information on the video options that are currently being developed or considered and allow for advocate input.
  9. Provide training to ALJs on remote fair hearings. In our April 5, 2022 email we requested Word documents of trainings provided to ALJs regarding remote fair hearings. We are in receipt of the public transmittals sent on April 13, 2022. We urge OTDA to develop trainings for ALJs on remote fair hearings with the input of advocates. We suggest that these trainings include how to conduct a remote fair hearing with an interpreter and issues relating to credibility determinations in this context. Please also refer to our proposed edits to the model opening statement.
  10. In furtherance of OTDA’s Transparency Initiatives, provide data or reports produced by OTDA for monitoring the progress of the Demonstration and publish all data on OTDA’s website.6
  11. Provide the following data from March 12, 2020 through the present, and publish all reporting on OTDA’s website:7
    1. Number of hearings requested by county and issue
    2. Number of hearings conducted via telephone by county and issue
    3. Number of hearings conducted via telephone by county and issue
    4. Number of hearings conducted via video by county and issue
    5. Number of hearings conducted in person by county and issue
    6. Number of telephone hearings that have been defaulted by county and issue
    7. Number of in-person hearings that have been defaulted by county and issue
    8. Number of video hearings that have been defaulted by county and issue
    9. Number of telephone hearings in which the Appellant submitted evidence by county and issue
    10. Number of in-person hearings in which the Appellant submitted evidence by county and issue
    11. Number of video hearings in which the Appellant submitted evidence by county and issue
    12. Number of telephone hearings in which an interpreter was present by county and issue
    13. Number of in-person hearings in which an interpreter was present by county and issue
    14. Number of video hearings in which an interpreter was present by county and issue
    15. Number of telephone hearings in which the Appellant was unrepresented by county and issue
    16. Number of in-person hearings in which the Appellant was unrepresented by county and issue
    17. Number of video hearings in which the Appellant was unrepresented by county and issue

12. Improve hearings for LEP individuals by doing the following:

    1. Schedule all hearings for LEP individuals in-person and allow LEP Appellants to affirmatively opt-in to a phone hearing based on their preference.
    2. Provide advocates with any guidance OTDA or OAH has created specifically for interpreters at phone hearings so that advocates can make suggestions for improvements. If no guidance has been issued, create a working group to develop such guidance.
    3. Develop systems to ensure the interpreter is provided with the documents in advance of the hearing.
    4. Require agencies to translate common documents so LEP Appellants can respond to the agency’s evidence.
    5. Improve ALJ Phone Script: Please refer to the edited attached Model Opening Statement.

13. Provide a liaison to advocates on urgent and emergent fair hearing issues.

14. Continue to engage with advocates and stakeholders in developing and improving remote hearing practices and policies.


1 New York State Office of Temporary and Disability Assistance (OTDA) Annual Report (2021), available online at https://otda.ny.gov/resources/reports/OTDA-Annual-Report-2021.pdf.
2 This recommendation relates to a spate of recent cases where fair hearing requests were processed incorrectly, and aid continuing was wrongly denied by front line staff and later corrected by a supervisor.
3 18 N.Y.C.R.R. § 358-6.4; 42 C.F.R. § 431.244(f)(1)
4 7 C.F.R. § 273.15(c)
5 U.S. Department of Agriculture, Food and Nutrition Service, SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM (SNAP): RECIPIENT CLAIMS ADMINISTRATION CHALLENGES AS A RESULT OF RESPONDING TO THE COVID-19 PUBLIC HEALTH EMERGENCY, Nov. 10, 2021, available at https://fns-prod.azureedge.us/sites/default/files/resource-files/SNAP-claims-administration-flexibility-memo.pdf
6 Office of Temporary Disability Administration, GOVERNMENT TRANSPARENCY INITIATIVES REPORT, October 2021, available at https://otda.ny.gov/news/attachments/OTDA-Transparency-Initiative-Report.pdf.
7 This request models the fair hearing data provided in OTDA’s Annual Report, and supplements it with data related to the Demonstration. Office of Temporary Disability Administration , 2021 ANNUAL REPORT, available at https://otda.ny.gov/resources/reports/OTDA-Annual-Report-2021.pdf


 

We thank for you again for the opportunity to engage in these discussions. The telephonic hearing process and the ongoing delays in scheduling, issuing decisions and compliance are causing unacceptable harm to appellants throughout New York State. We continue to hear of ways in which the current system fails to uphold the due process rights of public benefit recipients and applicants. The initial recommendations set out in this letter are the first steps in remedying defects that have existed in the “temporary” system that has now been in place for over two years. Should OTDA move forward with any of these recommendations, this should not be construed as acceptance on behalf of the undersigned organizations that all issues with the demonstration project have been identified or resolved. OTDA must continue to engage with advocates and involve stakeholders in developing and improving remote hearing practices and policies.

Respectfully,

 

Belkys Garcia, Staff Attorney
The Legal Aid Society
199 Water Street, 3rd Floor
New York, New York 10038

Susan C. Antos, Senior Attorney
Jessica Radbord, Senior Attorney
Empire Justice Center
119 Washington Avenue, Suite 301
Albany, NY 12210

Kelly Barrett Sarama, Supervising Attorney
Robert Neill, Staff Attorney
Center for Elder Law & Justice
438 Main Street, Suite 1200
Buffalo, New York 14202

Fiona Wolfe, Senior Attorney
Alexia Mickles, Staff Attorney
Empire Justice Center
One West Main Street, Ste. 200
Rochester, New York 14614
(585) 295-5736

Elizabeth Jois, Senior Staff Attorney
Abby Biberman, Senior Supervising Attorney
Rebecca Wallach, Supervising Attorney Evelyn Frank Legal Resources Program
New York Legal Assistance Group
7 Hanover Square, 18th Floor
New York, New York 10004

Paula Arboleda, Director of Health Advocacy
Jack Newton, Director of Public Benefits
Legal Services NYC
349 East 149th Street, 10th Floor
Bronx, New York 10451


GAO Finds SSA’s Treatment of Critical Cases Inconsistent

Posted on July 31st, 2022

The Government Accountability Office (GAO) has issued a report finding fault with the Social Security Administration’s (SSA’s) implementation of its policies for the expediting critical cases at the hearing level. See GAO-22-104191. The GAO found that SSA flags appeals as critical after determining the claimant’s health or financial circumstances, such as terminal illness or dire financial need, meet SSA’s criteria as set forth in HALLEX I-2-1-40. But the cases are not always identified or expedited.

 

“Critical” cases include “TERI” cases, or those where a claimant’s illness is identified as terminal; VAPT, or Veteran 100 Percent Permanent and Total; MC/WW, or Military Casualty/ Wounded Warrior Case; CAL, or those cases identified as Compassionate Allowances per POMS DI 11005.604; DRND, or Dire Need Cases, where a claimant may be without food, education, or shelter; or Potentially Violent, where there is an indication the claimant is suicidal, homicidal, or potentially violent. Hearing offices flag critical cases for expedited processing based on evidence that the above criteria are met. Receiving a flag does not ensure that the claim will be approved, only that it should receive expedited processing.

 

The GAO found that while hearing offices consistently processed critical cases faster than non-critical cases between 2010 and 2020, the wait times varied depending on when the case was first flagged. Cases that arrived at hearing offices already flagged were processed more quickly than those first flagged at the hearing office – a median of 201 days versus 351. The GAO also found that although SSA may have initially identified a case as dire, such designations do not always trigger expedited processing unless and until it is also “flagged” by the hearing office as fitting into one of the HALLEX categories. For example, only 28.5 percent of cases with a homelessness designation also had a critical case flag and selected for expedited processing. Finally, the GAO found that even though SSA policy does not require claimants to provide documentation of dire financial need, some hearing offices required documentation before expediting claims.

 

The GAO recommended that SSA review the requirements for documentation of dire need for consistency and examine its handling of cases indicating critical need to ensure they are expedited in accordance with policy. SSA agreed with these recommendations.

 


EMs Issued on Same Sex Marriages

Posted on July 31st, 2022

The Social Security Administration (SSA) has issued two Emergency Messages (EMs) implementing court decisions requiring payment of benefits to survivors of same-sex relationships who were unable to marry prior to the number-holder’s death due to an unconstitutional state law prohibiting same-sex marriage.

 

EM-21007 REV 2 provides instructions for handling claims, appeals, and reopening requests based on the decision in Thornton v. Commissioner of Social Security, 2:18-cv-01409-JLR (W.D. Wash.). A nation-wide class action, it prohibited SSA from denying benefits without determining whether the survivors of same-sex relationships would otherwise be eligible for widow(er)’s benefits but were prevented from marrying prior to November 25, 2020. The EM provides a series of questions, as well as examples, to help adjudicators establish whether the couple would have been married but for the unconstitutional state law.

 

EM-20046 REV 5 implements Ely v. Saul, No. CV-18-0557-TUC-BGM (D. Ariz.), which prohibits SSA from denying benefits to the surviving spouse of a same-sex ceremonial marriage who would otherwise be entitled to widow(er)’s benefits but for the nine-month marriage requirement of 42 U.S.C. § 416(c)(1). SSA must consider whether the couple would have been married sooner but for an unconstitutional state law that prohibited same-sex marriage. This EM also provides guidance for evaluating the circumstances that prevented the couple from meeting the nine-month duration requirement, including examples.

 

Lambda Legal, along with local firms, litigated the claims that resulted in these EMs, which have had a profound effect on surviving spouses who would otherwise be without these important benefits. The New York Times profiled Helen Thorton, one of the plaintiffs, who had been with her spouse for thirty years but was unable to marry her before she died in 2006, six years before Washington State made same-sex marriage legal in 2012. Ms. Thorton, who had struggling financially on just her own retirement benefits, had her income nearly double when the litigation was settled. And she received a retroactive award of $72,000 for the years that SSA had denied her application. Similarly, Anthony Gonzalez was finally able to marry his partner in New Mexico in 2013, as soon as same-sex marriage was legalized. But his spouse died six months later. In financial straits, Mr. Gonzalez applied for but was denied widower’s benefits based on the nine-month marriage requirement. His experience was cited in the Ely. He is now receiving survivor’s benefits and received a substantial retroactive payment.  

 

Lambda Legal encourages surviving same-sex partners to apply for benefits if they might be eligible. It has posted information to guide applicants.

 


Ukrainian Refugees May Be Entitled to SSI

Posted on July 31st, 2022

President Biden signed the Additional Ukrainian Supplemental Appropriations Act on May 21, 2022, which allows citizens, nationals, or residents of Ukraine paroled to the United States between February 24, 2022, and September 30, 2023, to receive Supplemental Security Income (SSI) benefits if otherwise eligible for seven years. Sponsor deeming will not apply.  These provisions comport with SSI eligibility provisions for refugees and asylees.

 

See the Immigrant Eligibility for Public Benefits in New York State chart that maps out noncitizen eligibility for a number of federal and New York State benefits, prepared and updated by the Empire Justice Center and New York Immigrant Coalition. See also the April edition of this newsletter for details on potential SSI eligibility for Non-Special Immigrant Parolees from Afghanistan under Section 2502 of the Afghanistan Supplemental Appropriations Act, 2022.

 


SSA Updates Guidance Regarding Transgender Individuals

Posted on July 31st, 2022

The Social Security Administration (SSA) has issued guidance for processing requests for Social Security numbers (SSNs) by transgender individuals. According to a press release issued on March 31, 2022, by Acting Commissioner Kilolo Kijakazi, the agency anticipates that SSA will allow people to self-select their sex on SSNs application in the fall of 2022. SSA’s systems, however, do not accommodate a sex designation other than M or F. Therefore, applications for original SSNs still must include a binary designation (M or F). The agency is exploring possible future policy and systems updates to support an “X” sex designation for the SSN card application process.

 

In the meantime, people who want to update their sex markers will need to apply for replacement SSN cards, even though SSN cards do not include sex markers. They will still need to show a current document to prove their identity, but they will no longer need to provide medical or legal documentation of their sex designation once the policy change becomes effective.  Emergency Message (EM)-22005 provides instructions for acceptance of evidentiary documents with a non-binary or unspecified sex designation, such as an X, instead of M for male and F for female in requests for Social Security numbers (SSNs). According to the EM, documents should not be rejected solely because of a non-binary or unspecified sex designation.

 

In late January 2022, SSA also issued POMS GN 00203.008 – Interviewing Transgender Individuals. In addition to providing general background on transgender identity and gender transition, the POMS reminds interviewers to “provide sensitive service to all individuals, and treat them with dignity and respect.” Interviewers should protect confidentiality of the individual; ask only questions necessary to complete the transaction; use the name and pronouns appropriate to the individual’s self-identified gender, even if the person has not changed his or her name or updated his or her records; and be aware that the individual’s gender transition is a personal matter. Questions or comments regarding a person’s medical treatment and appearance are inappropriate.

 


Advocates Demand Follow-up to SSA Equity Plan

Posted on July 31st, 2022

On June 3, 2022, a group of national advocates led by Community Legal Services in Philadelphia and Justice in Aging sent a letter to the Commissioner of Social Security, Kilolo Kijakazi, requesting that the Social Security Administration (SSA) meet with advocates to discuss the agency’s Equity Action Plan.  The letter urged the agency to prioritize two key areas: improving access to the local field offices and eliminating barriers to service for people with limited English proficiency. The letter was signed by 35 organizations, including the Empire Justice Center, Legal Services NYC, New York Legal Assistance Group, and the Urban Justice Center.

 

As detailed in the last issue of this newsletter, SSA released its agency’s Equity Action Plan on April 14, 2022.  The plan had been issued in response to an Executive Order (EO) 13985, signed on January 20, 2021, by President Biden, directing all federal agencies conduct an assessment of its programs and within one year provide a plan for advancing equity, including a plan to address barriers to enrollment in and access to benefits and services in its programs.

 

While there has been no direct response to the advocate sign-on letter, SSA held a “Stakeholder Engagement Meeting” on June 16, 2022, that was open to the public and at which the agency reviewed, in relatively broad strokes, some elements of the plan.  Many legal services organizations submitted comments in response to a request for information issued last year by the Office of Management and Budget, and continue to hope for an opportunity to have a focused dialogue on improving equity, including those identified in the sign-on letter and in the comments submitted to OMB.

 


COVID-19 FAQ- Preguntas frecuentes sobre el Medicaid del Estado de Nueva York

Posted on May 26th, 2022

PANDEMIA DE COVID-19

PREGUNTAS FREQUENTES DE MEDICAID DEL ESTADO DE NUEVA YORK

Última actualización: 18 de abril de 2022

Para preguntas generales o consultas sobre el Medicaid del Estado de Nueva York por favor envíe un correo electrónico a nuestro correo de admisión, health@empirejustice.org

P. ¿Se puede terminar mi Medicaid en este momento?

R. No. Para todas las personas inscritas en Medicaid a partir del 18 de marzo de 2020, la cobertura de Medicaid debe continuar durante la emergencia de salud pública, independientemente de cualquier cambio en las circunstancias que de otro modo daría lugar a la terminación. (Las excepciones incluyen a un beneficiario que solicita voluntariamente la terminación o cuando alguien se muda fuera del Estado de Nueva York).

P. ¿Se puede terminar mi Medicaid cuando termine la emergencia de salud pública?

R. No estamos seguros. Por favor, preste especial atención a los avisos de Medicaid que reciba en los próximos meses. Mientras tanto, por favor, asegúrese de que toda su información de contacto está al día con el Distrito Local de Servicios Sociales / HRA (condado) o el Estado de Nueva York del Mercado de la Salud, lo que corresponda. Proporcionaremos actualizaciones a medida que sepamos más sobre lo que sucederá cuando termine la emergencia de salud pública, pero le animamos a que busque asistencia legal si tiene alguna pregunta sobre posibles terminaciones de Medicaid en un futuro próximo.

P. ¿Contará mi Beneficio del Seguro de Desempleo (UIB, por sus siglas en inglés) como ingresos para ser elegible para Medicaid?

R. Sí y no. Aunque los ingresos recibidos a través del UIB suelen ser ingresos contables a efectos del presupuesto de Medicaid, algunas personas elegibles al UIB recibieron una compensación semanal adicional de $600 dólares. Esto se conoce como Compensación por Desempleo Pandémico. La Ley CARES ordenó específicamente a los estados que no tuvieran en cuenta la compensación adicional de $600 dólares semanales por desempleo pandémico a la hora de determinar la elegibilidad para Medicaid. Por lo tanto, los pagos regulares de UIB recibidos se siguen contando como ingresos, mientras que la compensación adicional de $600 dólares semanales por desempleo pandémico no se cuentan como ingreso. Se puede encontrar una guía aquí. Esta norma también se aplica a la ayuda adicional (más reciente) de $300 dólares semanales por pérdida de salario que pueden haber recibido algunas personas con derecho a ella. La guía puede ser encontrada aquí. Tenga en cuenta que, aunque los beneficios por desempleo están sujetos a impuestos, el último proyecto de ley de alivio del COVID, promulgado el 11 de marzo de 2021, hizo que los primeros $10,200 de beneficios estuvieran libres de impuestos para las personas con ingresos menores a $150,000. Esto aplica para 2020 solamente.

P. ¿Contará mi cheque de estímulo como ingreso a los efectos de la elegibilidad de Medicaid?

R. Los pagos de estímulo no son ingresos tributables y, por lo tanto, no se cuentan en las determinaciones de elegibilidad basadas en el MAGI. Para las determinaciones no basadas en el MAGI, los pagos de estímulo tampoco son contados como ingresos, y son un recurso exento.

P. Pronto me toca la recertificación, ¿tendré que volver a certificar mi elegibilidad para Medicaid?

R. Los casos de Medicaid se están extendiendo y los individuos no tendrán que renovar su elegibilidad de Medicaid durante el período de emergencia. Todos los casos de Medicaid que estaban activos a partir del 18 de marzo de 2020, con fechas de finalización de la cobertura entre marzo de 2020 y ahora, se extenderán automáticamente por 12 meses. Si su caso de Medicaid estaba/está programado para terminar entre marzo de 2020 y el final de la emergencia de salud pública (PHE, por sus siglas en inglés), no necesita devolver sus formularios de renovación de Medicaid y su caso se extenderá por un año. Los formularios de recertificación que vencen después de la expiración de la PHE (probablemente en el segundo trimestre de 2022) deben ser devueltos o usted puede perder la cobertura cuando su autorización expire.

TENGA EN CUENTA: esto se aplica a los casos de Medicaid solamente, para la población MAGI, obtenido a través del Estado de NY de Mercado de la Salud. Si tiene preguntas sobre su caso de SNAP/TA/Medicaid, obtenido a través de los servicios sociales del distrito local, hay diferentes actualizaciones, por lo que le animamos a buscar asistencia legal.

P. ¿Pueden aumentarse/reducirse mis beneficios de Medicaid durante la crisis del Coronavirus?

R. Sí, sus servicios pueden aumentar. Por ejemplo, si usted tiene un cambio de circunstancias y ahora necesita un aumento de los servicios de cuidado en el hogar, su médico puede seguir iniciando la solicitud sobre la base de sus necesidades médicas. Hay cambios en muchos de los procesos “normales”, como el requisito de las evaluaciones en el hogar y la forma en que los nuevos solicitantes certifican su elegibilidad. Si encuentra obstáculos de procedimiento para acceder a los servicios que necesita, le animamos a que solicite asistencia jurídica. Si recibe una notificación de reducción de los servicios, actúe rápidamente para apelar contra la reducción propuesta y solicite asistencia jurídica.

P. Estoy esperando la fecha de mi Audiencia Justa, ¿qué pasa ahora?

R. La Oficina de Asistencia Temporal y Discapacidad del Estado de Nueva York (OTDA, por sus siglas en inglés) emitió una declaración al comienzo de la crisis en la que decía que pasaría a realizar audiencias justas en la mayor medida posible utilizando el teléfono, el vídeo y otros medios de comunicación.  En la práctica, la mayoría de las audiencias justas se están llevando a cabo por teléfono, con avisos que proporcionan información e instrucciones sobre cómo se llevará a cabo la audiencia telefónica en la fecha asignada. Si usted encuentra problemas con una nueva fecha de audiencia justa, incluyendo retrasos en la programación, o tiene preguntas o preocupaciones acerca de cómo usted será capaz de representarse a sí mismo en el futuro debido a la crisis, le animamos a buscar asistencia legal. La OTDA anunció recientemente que las audiencias justas telefónicas continuarán hasta marzo de 2023.

Si ha estado recibiendo Ayuda para Continuar desde el 18 de marzo de 2020 o después, su cobertura se mantendrá hasta después de que se tome una decisión final sobre el fondo. La cobertura de Medicaid no puede reducirse ni interrumpirse.

P. ¿Qué pasa si yo (o alguien que conozco) necesito(a) ahora servicios de atención en el hogar?

R. Las solicitudes de Medicaid se siguen tramitando, incluyendo la inscripción en servicios de atención en el hogar y en residencias de ancianos. Se permitirá la certificación de todos los factores de elegibilidad para todos los casos de Medicaid, incluyendo los casos de hogares de ancianos. En el caso de la ciudadanía y el estatus de inmigración, las personas cuyo estatus no pueda verificarse a través de la Administración de la Seguridad Social podrían tener derecho a una prórroga para presentar la documentación.

Para obtener ayuda con la solicitud de Medicaid, busque aquí un Navegador en su zona geográfica. Si necesita ayuda para inscribirse en un plan de atención administrada de cuidado a largo plazo (MLTC, por sus siglas en inglés), póngase en contacto con el Red de Defensa del Consumidor Independiente (ICAN, por sus siglas en inglés).

Las autorizaciones iniciales de Servicios de Cuidado Personal (PCS), Servicios de Asistencia Personal Dirigidos por el Consumidor (CDPAS, por sus siglas en inglés) y otros servicios y apoyos a largo plazo basados en la comunidad (CBLTSS, por sus siglas en inglés) (es decir, servicios de enfermería en el hogar, terapias en el hogar, servicios de asistencia de salud en el hogar, atención médica diurna para adultos y enfermería privada) y las solicitudes de cambios en las autorizaciones de servicios, seguirán requiriendo una Evaluación de Salud de la Comunidad (CHA, por sus siglas en inglés) completada.

Hasta que el Departamento de Salud del Estado de Nueva York proporcione un nuevo aviso, todas las consultas para la autorización inicial de estos servicios y para las solicitudes de cambios en las autorizaciones de servicios deben realizarse en persona o a través de los servicios de telesalud permitidos. La capacidad de realizar la CHA por teléfono – una flexibilidad que se había introducido en respuesta a COVID-19 – ha sido anulada por el DOH, (por sus siglas en ingles).

Si tiene más preguntas o necesita ayuda sobre un asunto de seguro médico, póngase en contacto con nuestro equipo de salud por correo electrónico, health@empirejustice.org.

Por favor, tenga en cuenta: No nos envíe ninguna información no pública sobre ningún asunto legal para el que busque representación legal hasta que se lo solicitemos. Los abogados de Empire Justice le informarán si y cuando su asunto sea considerado para representación legal. Hasta ese momento, cualquier información que usted proporcione NO SE considerará confidencial, y NO se formará ninguna relación abogado-cliente por las comunicaciones recibidas a través de este sitio web. Toda la información disponible en el sitio web es sólo para fines de educación legal general, y no es asesoramiento legal.

 


COVID-19 FAQ- Preguntas Generales Sobre el Seguro de Salud

Posted on May 3rd, 2022

PANDEMIS DE COVID-19 PREGUNTAS FRECUENTES DE SEGURO SALUD DEL ESTADO DE NUEVA YORK

Última actualización: 19 de abril de 2022

PREGUNTAS GENERALES SOBRE EL SEGURO DE SALUD

P. He oído que los planes de seguro de salud ahora tienen que proporcionar pruebas de antígeno COVID-19 gratuitas o reembolsables en casa. ¿Es eso cierto? ¿Cómo funciona esto?

R. Si. Encuentre su tipo de seguro a continuación y si tiene más preguntas, le animamos a que se ponga en contacto con nosotros para obtener asistencia legal. Además, si su hogar no ha recibido la primera o segunda entrega de 4 pruebas COVID-19 gratuitas del gobierno federal, puede visite aquí.

P. No tengo seguro médico, ¿es demasiado tarde para solicitarlo en el New York State of Health (NYSOH) Marketplace?

R. El Estado de Nueva York administra su programa de intercambio de seguros de salud y, a la luz de la emergencia de salud pública COVID-19, extendió el Período de Inscripción Abierta (OEP, por sus siglas en inglés) durante la duración de la emergencia de salud pública. Durante este OEP, las personas no aseguradas pueden inscribirse en una cobertura de seguro a través del NYSOH Markeplace o directamente a través de las aseguradoras (Qualified Health Plans).

El Estado de Nueva York financia el programa de Asistentes/Navegadores en Persona para proporcionar asistencia a las personas interesadas en buscar e inscribirse en un seguro de salud a través del Marketplace. Busque  aquí para obtener asistencia en su área geográfica.

P. ¿Cómo puedo saber si mi seguro de salud ofrece telemedicina?

R. La telesalud o telemedicina es, en términos generales, la prestación de servicios de salud a distancia mediante el uso de tecnologías electrónicas de información y comunicación. A medida que el sector de la salud se va adaptando durante la crisis, vemos una rápida expansión de la necesidad de servicios de telesalud que permitan a las personas visitar a su proveedor desde casa, y sin ponerse en riesgo a sí mismos o a otros. El acceso a la telesalud también se ha ampliado para los beneficiarios de Medicare, lo que permite a las personas recibir determinados servicios a través de la telesalud, como las visitas rutinarias al consultorio, el asesoramiento sobre salud mental y los exámenes médicos preventivos.

Si necesita ver a un proveedor de atención médica, por cualquier motivo, pregunte sobre las opciones de telesalud disponibles y si estarán cubiertas para su necesidad médica específica. En el caso de los planes patrocinados por el empleador, los planes del marketplace y otros tipos de seguro de salud, también puede llamar a su plan de salud o buscar en línea sus beneficios en el portal de miembros de su póliza para obtener la información más actualizada.

P. ¿Qué pasa si yo (o mi cónyuge) hemos sido despedidos debido a la pandemia? ¿Sigo teniendo seguro de salud?

R. Dependiendo del tamaño de su empresa y del tipo de plan de salud, puede tener la opción de pagar una cobertura continuada en el plan de salud de grupo durante un máximo de 36 meses. Esto se conoce como cobertura de COBRA. Si cumple los requisitos, recibirá una notificación del administrador del plan sobre su opción de contratar la continuidad de la cobertura. Esta puede ser una forma de mantener la misma cobertura y el acceso a todos los mismos proveedores y medicamentos cubiertos sin complicaciones. En esta época de crisis, a muchas personas les resultará tentador, sobre todo a las que siempre han tenido cobertura a través de su empresa, inscribirse de inmediato. Sin embargo, COBRA suele ser mucho más caro porque los empleadores suelen pagar parte de los costos del seguro. Una vez que elija la cobertura de COBRA, el importe total de ese costo puede ser cargado a usted como individuo. Por lo menos, asegúrese de conocer el importe del aumento del costo y determine si va a ser asequible en el futuro.

Por lo general, tendrá 60 días para elegir la continuación de la cobertura de COBRA después de perder la cobertura de su empleador. También dispondrá de un período de inscripción especial (SEP, por sus siglas en inglés) para adquirir una cobertura de seguro de salud a través del Marketplace de NYSOH durante 60 días.

Instamos a todas las personas que se encuentren en esta situación de pérdida de empleo durante la crisis a que hagan una pausa y den un paso atrás antes de tomar una decisión precipitada con respecto al seguro de salud. Es importante considerar todas las opciones que puedan ser más accesibles dado cualquier cambio, ya sea a corto o largo plazo, en las finanzas de su hogar. Dependiendo de su edad, de los ingresos y recursos de su hogar y de las necesidades médicas previstas, puede haber otras opciones que ofrezcan una cobertura completa a un costo mucho menor que la cobertura de COBRA, como Medicaid, el Essential Plan, los Qualified Health Plans subvencionados o Child Health Plus.

Aunque la información anterior es generalmente cierta, el 11 de marzo de 2021, el presidente Biden firmó la Ley del Plan de Rescate Americano de 2021 (“ARP”, por sus siglas en inglés). El ARP establece que las personas que reúnen los requisitos no tienen que realizar los pagos de las primas de COBRA durante un máximo de 6 meses para las fechas de entrada en vigor del 1 de abril de 2021 al 30 de septiembre de 2021. Durante este tiempo, el empleador del individuo haría los pagos en su nombre y luego reclamaría esos pagos como una cancelación en los impuestos del próximo año.

Para saber si es usted una persona “cualificada” a efectos de este programa, haga clic aquí.

Si es posible, hable con un Asistente/Navegador en persona sobre las opciones que tiene a su disposición a través del Marketplace. Puede buscar  aquí  para obtener asistencia en su área geográfica.  Para los que tienen derecho a Medicare, la coordinación de la cobertura de COBRA traerá aún más desafíos. No existe un periodo de inscripción especial para Medicare cuando finaliza COBRA. Si no se inscribe inmediatamente en la Parte B de Medicare y no tiene otra cobertura activa patrocinada por el empleador cuando finalice COBRA, puede enfrentarse a costosas y continuas penalizaciones en las primas de la Parte B por inscripción tardía.

Las personas que deseen inscribirse en Medicare por primera vez dentro de su periodo de inscripción inicial pueden hacerlo por internet en www.ssa.gov (por ejemplo, cumplir 65 años). Los solicitantes de Medicare bajo un periodo de inscripción especial pueden enviar sus formularios por correo o por fax a la oficina local del Seguridad Social. Haga clic aquí para mas información. Llame a la línea de ayuda del Programa de Asistencia para el Asesoramiento sobre Seguros de Salud (HIICAP, por sus siglas en inglés) al 1-800-701-0501 para hablar con un consejero, o 1-800-Medicare para obtener más ayuda y orientació

P. He oído que las pruebas del coronavirus son gratuitas para todos los neoyorquinos, ¿es eso cierto?

R. Si, prueba de coronaviruses gratuita para todos los neoyorquinos que reúnan los requisitos, según lo ordene un proveedor de salud o llamando a la línea directa de COVID-19 del Estado de Nueva York al 1-888-364-3065. Su departamento de salud local es su contacto en la comunidad para asuntos relacionados con COVID-19. Tenga en cuenta que es posible que no pueda ser elegible para la prueba debido a los suministros limitados y a los estrictos requisitos de elegibilidad. También es importante tener en cuenta que si acude a un centro de pruebas administrado por el Estado de Nueva York, nunca se cobra por la prueba. Sin embargo, si acude a un centro de pruebas administrado por gobiernos locales, empresas privadas, incluidas farmacias y consultorios médicos, u organizaciones sin fines de lucro, se le aconseja que verifique con el centro de pruebas y con su aseguradora antes de someterse a la prueba para confirmar que no tendrá que pagar ninguna tarifa asociada a su prueba.

La cobertura para los no asegurados/insuficientemente asegurados dependerá de una serie de factores. Si no está seguro de su derecho a la cobertura, le recomendamos que solicite asistencia legal.

P. Ahora puedo recibir la vacuna o el refuerzo de COVID-19. ¿Cuánto me costará?

R. Las vacunas COVID-19 son gratuitas y están disponibles para todas las personas que reúnan los requisitos, independientemente de su situación en términos de inmigración o de seguro médico. No debería tener que pagar nada de su bolsillo para recibir la vacuna, aunque se le pedirá la información del seguro. Si no tiene seguro, se le administrará la vacuna de forma gratuita. Las vacunas y su administración, incluyendo las visitas necesarias para obtener la vacuna, deben estar cubiertas sin costo alguno (es decir, la vacunación y la administración no pueden estar sujetas a deducibles anuales, coaseguros, copagos o cualquier otro costo de bolsillo). Sin embargo, aunque no se pueden exigir servicios adicionales para que alguien reciba la vacuna, éstos pueden proporcionarse al mismo tiempo y facturarse como corresponde. Si le preocupa una posible factura sorpresa, asegúrese de hablar con su proveedor o con la farmacia acerca de cualquier cargo oculto. Más información sobre la vacuna se puede Encontrar aquí.

A todos los afiliados a Medicare y al plan Medicare Advantage: La vacunación y la administración serán facturado a Original Medicare (Part B). Asegúrese de llevar su tarjeta de Medicare cuando se vacune para que su proveedor de salud o farmacia pueda facturar a Medicare. Los que están en un plan de Medicare Advantage pueden no estar acostumbrados a ver un Aviso resumido de Medicare (MSN). El MSN, (por sus siglas en inglés), es un aviso que todas las personas con Medicare Original reciben por correo cada 3 meses y que muestra todos los servicios o suministros cubiertos por la Parte A y la Parte B facturados a Medicare durante el período de 3 meses, lo que Medicare pagó y la cantidad máxima que usted puede deber al proveedor. Como los afiliados a un plan Medicare Advantage también tendrán sus servicios de vacunación y administración facturados a Medicare Original (Parte B), también pueden recibir un MSN, indicando que la vacuna fue facturada a la Parte B y que no se debe ninguna cantidad.

¡Cuidado con el fraude en las vacunas! Para ayudar a erradicar el fraude en la vacunación o las estafas en todo el Estado, Nueva York estableció una línea telefónica a la que los neoyorquinos pueden llamar para denunciar sospechas de fraude. Es una señal de alarma si alguien le promete la vacuna a cambio de un pago, o si alguien le pide su número de Medicare. Para hacer una denuncia, llame a 1-833-VAX-SCAM (1-833-829-7226) o envíe un correo electrónico a STOPVAXFRAUD@health.ny.gov.

Si tiene más preguntas o necesita ayuda sobre un asunto de seguro médico, póngase en contacto con nuestro equipo de salud por correo electrónico, health@empirejustice.org.

Por favor, tenga en cuenta: No nos envíe ninguna información no pública sobre ningún asunto legal para el que busque representación legal hasta que se lo solicitemos. Los abogados de Empire Justice le informarán si y cuando su asunto sea considerado para representación legal. Hasta ese momento, cualquier información que usted proporcione NO SE considerará confidencial, y NO se formará ninguna relación abogado-cliente por las comunicaciones recibidas a través de este sitio web. Toda la información disponible en el sitio web es sólo para fines de educación legal general, y no es asesoramiento legal.


COVID-19 FAQ- NYS Health Insurance

Posted on April 19th, 2022

COVID-19 PANDEMIC

FAQS NEW YORK STATE HEALTH INSURANCE  

Last Updated: April 19, 2022

GENERAL HEALTH INSURANCE QUESTIONS

Q. I heard health insurance plans now have to provide free or reimbursable at-home COVID-19 antigen tests. Is that true? How does this work?

A. Yes. Find your insurance type below and if you have further questions, we would encourage you to reach out for legal assistance. Also, if your household has not received your first or second batch of 4 free COVID-19 tests from the federal government, you may visit here.

  • Private or commercial insurance plans (typically through employer): Beginning January 15, 2022, individuals with private health insurance coverage or covered by a group health plan who purchase an over-the-counter (OTC) COVID-19 diagnostic test will be able to have those test costs covered by their plan or insurance.
    • This requirement does not apply to any OTC tests purchased prior to 1/15/22.
    • The OTC test must be authorized, cleared, or approved by the U.S. Food and Drug Administration
    • A maximum of 8 tests will be covered per enrolled individual, per month (a family of 4, all on the same plan, would be able to get up to 32 of these tests covered by their health plan per mfonth).
    • There is no coverage for at-home tests purchased to fulfill an employment, school or travel requirement.
    • To find out how your plan is providing free or reimbursable tests to its members, reach out to your plan
    • There is no limit on the number of tests, including at-home tests, that are covered if ordered or administered by a health care provider following an individualized clinical assessment, including for those who may need them due to underlying medical conditions.
  • Medicare, Medicare Advantage Plans: Beginning April 4, 2022, Medicare will cover up to 8 OTC at-home COVID-19 tests each calendar month at no cost. These tests will be covered by Part B for those enrolled in Part B. Please see this link for more info.
  • Medicaid, Medicaid Managed Care, Health and Recovery Plans, Child Health Plus, Essential Plan: members are eligible for 2 tests per week with an attending provider order. See NYS Medicaid Pharmacy Policy and Billing Guidance for At Home COVID-19 Testing Coverage.

Q. I don’t have health insurance, is it too late to apply on the New York State of Health (NYSOH) Marketplace?

A. New York State runs its own health exchange and, in light of the COVID-19 public health emergency, extended the Open Enrollment Period (OEP)  through the duration of the public health emergency. During this OEP, uninsured individuals can enroll in insurance coverage though the NYSOH Marketplace or directly through insurers (Qualified Health Plans.)

NYS funds the In-Person Assistor/Navigator program to provide assistance for individuals interested in shopping for and enrolling in health insurance through the Marketplace. Search here for assistance in your geographical area.

Q. How do I know if my health insurance plan offers telemedicine?

A. Telehealth or telemedicine is, broadly speaking, the provision of remote health care services through the use of electronic information and communication technologies. As the healthcare industry adapts during the crisis, we are seeing a rapid expansion in the need for telehealth services to allow people to visit with their provider from home, and without putting themselves or others at risk. Access to telehealth has also been expanded for Medicare beneficiaries, enabling individuals to receive certain services through telehealth including routine office visits, mental health counselling and preventative health screenings.

If you need to see a healthcare provider, for any reason, ask about available telehealth options and whether it will be covered for your specific medical need. For employer-sponsored, marketplace plans, and other types of health insurance, you can also call your health plan, or go online to search your benefits on your policy’s member portal for the most up to date information.

Q. What if I (or my spouse) was laid off due to the pandemic? Do I still have health insurance?

A. Depending on the size of your employer and the type of health plan, you may have the option to pay for continued coverage under the group healthcare plan for up to 36 months. This is known as  COBRA coverage. If eligible, you will receive notification from the plan administrator of your option to purchase continued coverage. This can be a hassle-free way to keep the same coverage and access to all the same providers and covered medications. In this time of crisis, it will be tempting for many people, especially those who have always had coverage via their employer, to sign up straight away. However, COBRA is usually much more expensive because employers have typically been paying part of the insurance costs. Once you elect for coverage under COBRA, the full amount of that cost can be charged to you as an individual. At the very least, make sure you know the amount of the increased cost and determine whether that is going to be affordable going forward.

Generally, you will have 60 days to elect COBRA continuation coverage after losing your employer coverage. You will also have a separate Special Enrolment Period (SEP) to buy health insurance coverage though the NYSOH Marketplace for 60 days.

We would urge anyone in this position of job loss during the crisis to pause and take a step back before making a hasty decision regarding health insurance. It is important to consider all options that may be more affordable given any change, either short term or long term, in your household finances. Depending on your age, household income and resources, and foreseeable medical needs, there may be other options that provide comprehensive coverage at a much lower cost than COBRA coverage, including Medicaid, the Essential Plan, subsidized Qualified Health Plans or Child Health Plus.

While the above information is generally true, on March 11, 2021, President Biden signed the American Rescue Plan Act of 2021 (“ARP”). The ARP provides that qualified individuals do not have to make COBRA premium payments for up to 6 months for effective dates April 1, 2021 – September 30, 2021. During this time, the individual’s employer would make payments on their behalf and then claim those payments as a write-off on next year’s taxes. To find out if you are a “qualified” individual for purposes of this program, click here.

If possible, speak to an In-Person Assistor/Navigator about the options that are available to you through the Marketplace. You can search  here for assistance in your geographical area.

For those who are Medicare eligible, coordinating COBRA coverage will bring even more challenges. There is no SEP for Medicare when COBRA ends. If you do not enroll in Medicare Part B immediately, and you do not have other active employer-sponsored coverage when COBRA ends, you may face costly and ongoing Part B premium penalties for late enrollment.

People who wish to enroll in Medicare for the first time under their Initial Enrollment Period may do so online at www.ssa.gov (i.e., turning 65). Medicare applicants under an SEP may mail or fax their forms to the local Social Security. Click here for more information. Call the Health Insurance Information Counseling Assistance Program (HIICAP) helpline at 1-800-701-0501 to speak to a counselor, or 1-800-Medicare for further assistance and guidance

Q. I heard coronavirus testing is free for all New Yorkers, is that true? 

A. Yes, coronavirus testing is free for all eligible New Yorkers as ordered by a health care provider or by calling the NYS COVID-19 hotline at 1-888-364-3065. Your local health department is your community contact for COVID-19 concerns. Be aware that you may not be eligible for testing due to limited supplies and strict eligibility requirements. It is also important to note that if you go to a test site run by New York State, there is never any charge for your test. However, if you go to a test site operated by local governments, private companies including pharmacies and medical practices or not-for-profit organizations, you are advised to check with the testing site and your insurer in advance of being tested to confirm you will not be responsible for any fees associated with your test.

Coverage for the uninsured/underinsured will depend on a variety of factors. If you are unsure of your eligibility for coverage, we would encourage you to reach out for legal assistance.

Q. I am now eligible for the COVID-19 vaccine or booster. How much will it cost me?

A. COVID-19 vaccines are free and available to all eligible individuals, regardless of immigration or health insurance status. You should not have to pay anything out of pocket to get the vaccine, although you will be asked for insurance information. If you don’t have insurance, you should still be given the vaccine at no charge. Vaccinations and administration, including any visits necessary to obtain the vaccination, must be covered without cost-sharing (i.e., vaccination and administration cannot be subject to annual deductibles, co-insurance, copayments or any other out-of-pocket cost). However, although additional services cannot be required in order for someone to receive the vaccine, they can be provided at the same time and billed as appropriate. If you are worried about a potential surprise bill, be sure to talk to your provider or pharmacy about any hidden fees. More info on the vaccine can be found here.

To all Medicare and Medicare Advantage Plan members: Vaccination and administration will be billed to Original Medicare (Part B). Be sure to bring your Medicare card with you when getting vaccinated so that your health care provider or pharmacy can bill Medicare. Those on a Medicare Advantage Plan may not be used to seeing a Medicare Summary Notice (MSN). The MSN is a notice that all people with Original Medicare receive in the mail every 3 months that shows all Part A and Part B-covered services or supplies billed to Medicare during 3-month period, what Medicare paid, and the maximum amount you may owe the provider. Since members in a Medicare Advantage Plan will also have their vaccination and administration services billed to Original Medicare (Part B), they may also receive an MSN, indicating the vaccine was billed to Part B and no amount should be owed.

Beware of vaccine fraud! To help root out vaccination fraud or scams across the State, New York established a hotline that New Yorkers can call to report suspected fraud. It is a red flag if anyone is promising you the vaccine in exchange for payment, or if anyone is asking for your Medicare Number. To make a report, call 1-833-VAX-SCAM (1-833-829-7226) or email STOPVAXFRAUD@health.ny.gov.

If you have any further questions, or need assistance on a health insurance matter, please contact our health team by email, health@empirejustice.org.

Please note: Do not send us any nonpublic information about any legal matter for which you seek legal representation until we request that you do so. Empire Justice attorneys will inform you if and when your matter is considered for legal representation. Until that time, any information you provide WILL NOT be considered confidential, and NO attorney-client relationship is formed by communications received through this website. Any information available on the website is for general legal education purposes only, and is not legal advice.


COVID-19 FAQ – NYS MEDICAID

Posted on April 18th, 2022

COVID-19 PANDEMIC

FAQS NEW YORK STATE MEDICAID

 

Last Updated: April 18, 2022

Q. Can my Medicaid be terminated at this time?

No. For everyone enrolled in Medicaid on or after March 18, 2020, Medicaid coverage must continue during the public health emergency, regardless of any change in circumstances that would otherwise result in termination. (Exceptions include a beneficiary who voluntarily requests termination or when someone moves out of NY State.)

Q. Can my Medicaid be terminated when the public health emergency ends?

We’re not sure. Please pay particular attention to any Medicaid notices you receive in the coming months. In the meantime, please make sure all your contact information is up-to-date with either the Local District Social Services/HRA (county) or the New York State of Health Marketplace, whichever applies. We will provide updates as we learn more about what will happen when the public health emergency ends, but we would encourage you to seek legal assistance if you have any questions about potential Medicaid terminations in the near future.

Q. Will my Unemployment Insurance Benefit (UIB) count as income for purposes of Medicaid eligibility?

Yes and no. Although income received through UIB is typically countable income for purposes of Medicaid budgeting, some eligible individuals who are collecting UIB received an additional weekly compensation payment of $600. This is known as the Pandemic Unemployment Compensation. The CARES Act specifically directed states to disregard the additional $600 weekly Pandemic Unemployment benefit when determining eligibility for Medicaid. So, the regular UIB payments received are still counted as income, while the additional $600 weekly Pandemic Unemployment benefit is not counted as income. Guidance can be found here. This rule also applies to the (more recent) additional $300 weekly Lost Wages Assistance that some eligible individuals may have received. Guidance can be found here.

Please note, although unemployment benefits are taxable, the newest COVID relief bill, enacted on March 11, 2021, made the first $10,200 of benefits tax-free for people with incomes of less than $150,000. This applies to 2020 only.

 

Q. Will my stimulus check count as income for purposes of Medicaid eligibility?

No. The stimulus payments are not taxable income and therefore not countable in MAGI-based eligibility determinations. For non-MAGI determinations, the stimulus payments are also not countable as income, and are an exempt resource.

Q. I am up for Recertification soon, will I be required to recertify my Medicaid eligibility?

No, Medicaid cases are being extended and individuals will not be required to renew their Medicaid eligibility during the emergency period.

All Medicaid cases that were active as of March 18, 2020, with coverage end dates between March 2020 and now, will be automatically extended for 12 months. If your Medicaid case was/is set to end between March 2020  through the end of the public health emergency (PHE), you do not need to return your Medicaid renewal forms and your case will be extended for one year. Recertification forms that are due after the expiration of the PHE (likely in the second quarter of 2022) must be returned or you may lose coverage when your authorization expires.

PLEASE NOTE: this applies to Medicaid-only cases, for the MAGI population, obtained through the NY State of Health Marketplace. If you have questions about your SNAP/TA/Medicaid case, obtained through the Local District Social Services, there are different updates so we would encourage you to reach out for legal assistance.

Q. Can my Medicaid benefits be increased/reduced during the Coronavirus crisis?

Yes, your services can be increased. For example, if you have a change in circumstances and now need an increase in home care services, your physician can still initiate the request based on your medical needs. There are changes in many of the “normal” processes – including the requirement for in-home assessments and the manner in which new applicants attest to their eligibility. If you encounter procedural blocks to accessing the services you need, we would encourage you to reach out for legal assistance. If you receive notice of a reduction in services, take action quickly to appeal against the proposed reduction and reach out for legal assistance.

Q. I am waiting for my Fair Hearing date, what happens now?

The NYS Office of Temporary and Disability Assistance (OTDA) issued a statement at the outset of the crisis that it will be transitioning to conducting fair hearings to the greatest extent possible utilizing telephone, video, and other means of communication.

In practice, most fair hearings are now being conducted by telephone, with notices providing information and instructions on how the telephonic hearing will take place on the assigned date. If you encounter issues with a new fair hearing date, including scheduling delays, or have questions or concerns about how you will be able to represent yourself going forward due to the crisis, we would encourage you to reach out for legal assistance. OTDA recently announced that telephonic fair hearings will continue through March 2023.

If you have been receiving Aid to Continue since March 18, 2020 or later, your coverage will be maintained until after a final decision is reached on the merits. Medicaid coverage cannot be decreased or discontinued.

Q. What if I (or someone I know) now need(s) home care services?

Medicaid applications are still being processed, including enrollment in homecare services and nursing homes. Attestation will be allowed for all factors of eligibility for all Medicaid cases, including nursing home cases. For citizenship and immigration status, individuals whose status cannot be verified through the Social Security Administration might be eligible for an extension to provide documentation.

For assistance with a Medicaid application, search here for a Navigator in your geographical area. For assistance with enrolling in a Managed Long Term Care (MLTC) plan, contact the Independent Consumer Advocacy Network (ICAN).

Initial authorizations for Personal Care Services (PCS), Consumer Directed Personal Assistance Services (CDPAS), and other community based long term services and supports (CBLTSS) (i.e., nursing services in the home, therapies in the home, home health aide services, adult day health care, and private duty nursing) and requests for changes in service authorizations, will continue to require a completed Community Health Assessment (CHA).

Until further notice is provided by NYS DOH, all CHAs for initial authorization of these services and for requests for changes in service authorizations must be conducted in-person or via permitted telehealth services. The ability to conduct the CHA by telephone – a flexibility that had been introduced in response to COVID-19 – has been rescinded by DOH.

If you have any further questions, or need assistance on a health insurance matter, please contact our health team by email, health@empirejustice.org.

Please note: Do not send us any nonpublic information about any legal matter for which you seek legal representation until we request that you do so. Empire Justice attorneys will inform you if and when your matter is considered for legal representation. Until that time, any information you provide WILL NOT be considered confidential, and NO attorney-client relationship is formed by communications received through this website. Any information available on the website is for general legal education purposes only, and is not legal advice.