FAQS NEW YORK STATE MEDICAID
Last Updated: May 7, 2020
Q. Can my Medicaid be terminated at this time?
No. For everyone enrolled in Medicaid on or after March 18, Medicaid coverage must continue through the end of the month in which the emergency period ends, 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. 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 will receive 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.
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 not countable as income, and are an exempt resource for 12 months. After the 12-month period, any portion of the stimulus payment remaining is a countable resource.
Q. I am up for Recertification soon, will I be required to recertify my Medicaid eligibility?
No, recent guidance states that Medicaid cases are being extended and individuals will not be required to renew their Medicaid eligibility during the emergency period. All active Medicaid cases with authorization and coverage dates ending in March, April, May, and June, will be automatically extended for 12 months. 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 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.
Q. Can my Medicaid benefits be reduced during the Coronavirus crisis?
We’re not sure. Regarding reductions, advocates have been seeking clarification that services, like home care, cannot be reduced. 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, it appears that all previously scheduled in-person fair hearings are being adjourned and the new notices will be sent out by mail with instructions on how the fair hearing will now take place. If you encounter issues with a new fair hearing date, or have 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.
Recent guidance states that 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). Effective immediately, and until further notice is provided by NYS DOH, registered nurses may conduct the CHA by telephone or permitted telehealth services.
This information is up to date as May 7, 2020. If you have any further questions, or need assistance on a health insurance matter, please contact our health team by email, email@example.com.
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.