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COVID-19 FAQ – NYS MEDICAID

Health Team April 18, 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.