January 20, 2015

CMS Approves Managed Care Transtion for Nursing Homes

Starting Feburay 1, 2015, the state will require new nursing home residents to enroll in mainstream Medicaid managed care and MLTC plans.The timeline for the transition is confirmed as follows:

NYC Boroughs - February 1, 2015

Long Island/Westchester - April 1, 2015 

Rest of NY State - July 1, 2015

If you have questions regarding the transistion please contact us at info@cowartdizzia.com


January 15, 2015

Medicaid Managed Care and Long Term Facilities: Mandatory Enrollment

New York State’s Medicaid program will shortly undergo a major transition that has been in the works since early 2014.  As of February 1, 2015, all individuals in need of long-term care placement in a nursing facility will be subject to mandatory enrollment in a Medicaid Care Managed Care Plan or a Managed Long Term Care Plan with a Managed Care Organization (MCO). This shift represents an expansion by New York of the use of Managed Care Organizations to administer government assistance benefits. For long-term care facilities, the introduction of mandatory MCOs will bring additional administrative measures to receive Medicaid payments for covered individuals. Instead of working with the Department of Social Services exclusively, facilities will now need to interface with DSS on eligibility and coordinate with MCOs to receive payment.

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November 10, 2014

A Closer Look at “Spousal Refusal”: MAP Correcting Illegal Practice of Denying "Spousal Impoverishment" Income Allowance also addresses community spouses' refusal to provide verifications and eligibility

Under Federal and State Medicaid regulations, acommunity spouse is entitled to the community spouse monthly income allowance (CSMIA) even if a spousal refusal to contribute resources has been completed.  This CSMIA may be deducted from the NAMI payments a resident must use to offset the cost of the skilled nursing home care received.   With the efforts of the Elder Law Section of the NYS Bar Association a new MAP was issued recognizing that a spousal refusal does not require the community spouse to forfeit their allowance.  The new directive correctly states that that the community spouse is entitled to the CSMIA even if a spousal refusal is completed, if complete information regarding income and resources is submitted.

We expect that this rule implementation to incentivize needy community spouses to cooperate more fully with the Medicaid application process.  

Moreover, the MAP clarifies that in cases where a spousal refusal is accompanied by the refusal to also provide documentation, the institutionalized spouse should not be denied Medicaid. The MAP clearly provides that an undue hardship exists in cases where a community spouse will not provide documentation and has completed a spousal refusal so long as the institutionalized spouse is otherwise (1) eligible for Medicaid and (2) unable to obtain appropriate medical care without Medicaid assistance.

For links to these documents and to the letters from the NYSBA and HRA, click here.