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HEALTH CARE RESOURCES PAGE

(For Information on the Medicare Part D Prescription Drug Program, follow this link)

(For Information on Supplemental Needs Trusts, follow this link)

New Additions:

Legal Aid Society has kindly translated a few of these documents into Spanish.  Here is a list of all the available Spanish versions of documents on our website:

Sample HIPAA Release Form

NYC HRA HIPAA Release Form

Basic Eligibility for Community Medicaid for Age 65+, Disabled and Blind

Q-Tips - Advocacy Tips for Completing the M11q Form (or doctor's order for Medicaid personal care services

UPDATE: Effective July 1, 2007, it will be mandatory for all EPIC members to join a Medicare Part D plan (with some exceptions). This memo from    Selfhelp explains this change, and how it will work. Revised June 12, 2007

NYS Dept of Health Personal Care Aide Scope of Practice

EPIC Part D Notification Letters 3 4 7 9

Legal Aid Society's Guide to Health Care Services for Low-Income New Yorkers

Stipulation of Settlement in Miller v. Bernstein

Memo on new requirement that all EPIC members join Part D

Medicaid Prescription Drug Formulary

GIS 06 MA/015 - New citizenship documentation requirements, effective 7/1/06

GIS 06 MA/016 - Advises LDSS that anticipated transfer penalties for home care and the elimination of spousal/parental refusal were rescinded in the final budget and will not be implemented.

PUBLIC HEALTH INSURANCE PROGRAMS OTHER THAN MEDICAID

A.   EPIC Prescription Drug Program

UPDATE: Effective July 1, 2007, it will be mandatory for all EPIC members to join a Medicare Part D plan (with some exceptions). This memo from    Selfhelp explains this change, and how it will work. Revised June 12, 2007   

    Elderly Pharmaceutical Insurance Coverage (EPIC) Program

    EPIC - New York State Senior Prescription Plan Letter

    EPIC Notice of Creditable Coverage

    EPIC Part D Notification Letters 3 4 7 9

    EPIC Provider Bulletin - December 2005 (Explains coordination with Medicare Part D)

    EPIC "Pink Letter" - Notice to 7,400 Full Extra Help-approved members that EPIC has intelligently auto-assigned them to a Part D plan

B.   Child Health Plus
 

C.   Family Health Plus

 

D.   Medicare Savings Program

Information on Medicare Savings Program 

    Short application for SLIMB & QI-1 Medicare Savings Programs Short application for SLIMB & QI-1 Medicare Savings Programs

Medicare Rights Center MSP Toolkit

   Here are helpful documents for the MSP application process.

E.   Private Long Term Care Insurance

NYS Partnership for Long Term Care (private nursing home insurance that qualifies person for Medicaid  after 3 years)

F.   Medicare and Medigap

   Comparison chart of Medigap policies 2006 - Medicare Rights Center

   Form to Dis-enroll from a Medicare Advantage (Medicare managed care) Plan

   NY Dept. of Insurance Medigap Premium tables - NYS)

G.   Help For the Uninsured

Legal Aid Society's Guide to Health Care Services for Low-Income New Yorkers

HHC Options - Information on Sliding Scale Care available at NYC Public Hospitals and Clinics

Medical Debt and Seniors: How Consumer Law Can Help

Health Insurance Portability and Accountability Act (HIPPA)

Limited POA for Medical Records ("Sklar" POA)

Sample Forms

Sample Form in Spanish

HRA HIPAA Form - Espanol

MEDICAID

A.   2006 Federal and State Medicaid Changes

Analysis of the ADM and the CMS Guidance of 7/27/06 Implementing the Deficit Reduction Act of 2005

CMS Guidance of 7/27/06 on the Asset Transfer Provisions of the DRA

06 ADM-5: Dep't of Health Transmittal Implementing the DRA

GIS 06 MA/016 - Advises LDSS that anticipated transfer penalties for home care and the elimination of spousal/parental refusal were rescinded in the final budget and will not be implemented.

Materials on Proposed Changes to Medicaid in Deficit Relief Act of 2006

Outline on Medicaid Cuts in Deficit Reduction Act of 2005 - Selfhelp Community Services

Summary of Medicaid Cuts in Deficit Reduction Act of 2005 - Selfhelp Community Services [10-page version of the Outline above]


B.   Citizenship Documentation Requirements - New

Proof Of Identity For Medicaid - New Requirements For People Who Do Not Have Medicare Or SSI

NYS Dept. of Health Chart of Documentation Required to Prove Citizenship and Identity for Medicaid (For people not on Medicare or SSI)

Summary of New Interim Regulation on Citizenship Documentation

GIS 06 MA/015 - New citizenship documentation requirements, effective 7/1/06

Overview of New Requirements on Citizenship Documentation for Medicaid Benefits (July 6, 2006)

Interim Final Rule on Implementation of New Documentation Requirements (July 6, 2006)

Federal Documentation Requirement for Citizens does not change the rule for Non-Citizens (National Immigration Law Center Fact Sheet) (June 21, 2006)


C.   Medicaid in General



D.   Medicaid Financial Eligibility
 
Financial Eligibility Levels for Medicaid, Medicare Savings Program, Family Health Plus, & Child Health Plus  (2008)

Form for Medicaid Applicant to indicate "Refusal" by Legally Responsible Relative to Contribute Income and Resources

New GIS 06 MA/016 - Advises LDSS that anticipated transfer penalties for home care and the elimination of spousal/parental refusal were rescinded in the final budget and will not be implemented.

Information on Medicaid Buy-In Program for Working People with Disabilities Under 65
     State DOH info     

Information on New "Resource Attestation" for Medicaid, including State ADM, HRA Alerts, and advocacy update

Medicaid Income Disregards Chart - 2008

Medicaid Resource Disregards Chart - 2008

Medicaid Spend-down Program in NYS - Training Outline

    GMHC posting about using ADAP to meet the spend-down

    Fact Sheet on using ADAP or EPIC to Meet the Spend-down

 
 
Basic Eligibility for Medicaid Home Care - Selfhelp Community Services, Inc. - Espaņol

Long Term Home Health Care Program Reference Manual (June 2006, 219 pp.)

Home and Community Based Services Medicaid Waiver for Individuals with Traumatic Brain Injury (HCBS/TBI) Program Manual (June 2006, 123 pp.)

NYS Dept. of Health Scope of Tasks for Certified Home Health Aides

NYS Dept of Health Personal Care Aide Scope of Practice

Advocacy Memo on Reimbursement for Home Care Services

Homecare Reimbursement Form
Homecare Reimbursement Worksheet [Excel template]
NYC Substitute W-9 Form
Affidavit for Requesting Reimbursement for Medicaid Home Attendant Services paid in cash (NYC) [Fillable PDF Form]

Form M-11q - NYC HRA Medical Request for Home Care (1.22 MB)

NEW - This version is a PDF form that can be filled out electronically using Adobe Reader. This means you can type your comments to increase legibility and fit more information on the page. Once you have finished entering your information, you can print the form. However, you cannot save the form with your entered information using the free Adobe Reader. Only the full version of Acrobat lets you do this.

Warning: This is a large file, and may take awhile to download. If you can expand Zip archives, try downloading this version. (995 KB)