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UPDATED: JUNE 2011

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OTHER ELIGIBILITY REQUIREMENTS APPLICATION, CERTIFICATION AND RENEWAL

NEW APPLICATION

Because FHPlus is a managed care-only product, new applicants MUST select a managed care plan AND complete a managed care enrollment form as a condition of eligibility unless the A/R resides in a district that has only ONE Family Health Plus Plan. It is strongly recommended that A/Rs complete Section K of the DOH-4220 Access NY Health Care Application or Section 19 of the LDSS-2921 or the Medicaid Managed Care and Family Health Plus enrollment form whenever possible to enable the A/R to provide primary Care provider or health center choice information. If the person fails to do so, the enrollment must be entered in accordance with procedures outlined in 01 OMM/ADM 6 Section IV. C. 3. In districts that have more than ONE Family Health Plus Plan, an application is not complete unless a plan has been selected.

Prior to making a plan selection, all Medicaid and FHPlus applicants must be informed about the managed care program, available plans in the county and optional benefits. This is known as managed care “education”. Managed care education may be conducted by mail, in person, by telephone or through FEs. Applicants may be referred to managed care workers or enrollment counselors at the time they choose to come into the LDSS to conduct business such as copying documents, requesting application assistance or to bring in required documentation. Districts must provide managed care education packets that include county specific information and a managed care contact for more detailed information.

MBI-WPD recipients with income below 150% of the federal poverty level may enroll in managed care. MBI-WPD recipients with income at or above 150% of the federal poverty level cannot be enrolled in managed care.

Persons in receipt of Medicare, regardless of their categorical status or income level cannot be enrolled in Medicaid managed care with some exceptions including Managed Long Term Care and Medicare Advantage Plans. Applications for the Medicaid Cancer Treatment Program are received and processed by State DOH/OHIP staff. (See CATEGORICAL FACTORS MEDICAID CANCER TREATMENT PROGRAM (MCTP))

SSI-related Medicaid applicants have the option of applying for:

1. Community Coverage without Long-Term Care which includes all Medicaid covered services except nursing facility services and (MRG)