Next Steps for Medicaid Recipients on NYSoH who are Medicare Eligible
Next Steps for Medicaid Recipients on NYSoH who are Medicare Eligible
Individuals with MAGI Medicaid on NYSoH during the public health emergency (PHE), who became Medicare eligible during the PHE, have maintained their Medicaid coverage on NYSoH; during the PHE, these cases were not transferred to the LDSS/HRA. These enrollees must renew their Medicaid coverage on NYSoH through the end of the month in which their Medicaid coverage ends (i.e., if their authorization ends June 30, they can renew only through June 30). Unlike others Medicaid enrollees with coverage on NYSoH, they do not have any late renewal enhancements.
Individuals with Medicaid who did not apply for Medicare when first eligible will be informed of this requirement; they must apply for Medicare as a condition of ongoing Medicaid eligibility.
Individuals who are Medicare-eligible, who have maintained Medicaid on NYSoH during the Public Health Emergency, will maintain their Medicaid coverage on NYSoH through the unwind period, unless they need managed long term care services or are determined upon renewal to have Medicaid with a spenddown. In these cases, their Medicaid coverage will be transferred to the LDSS/HRA.
In addition:
While dual eligibles are typically subject to resource limits in order to qualify for Medicaid, NYS obtained a waiver to not consider resources when renewing Medicaid coverage as part of the unwind process. (Note that for people newly applying for Medicaid, resource limits apply; the waiver only applies to those recertifying for coverage.)
Those with coverage end dates of June 30 or July 31 will have their Medicaid coverage extended for 4 months while a system update is put in place.
Enrollees will maintain coverage in their Medicaid Managed Care plan (MMC)/Health and Recovery Plan (HARP) until their renewal, at which point they will be enrolled in fee-for-service Medicaid through NYSoH. However, if they are enrolled in their Medicaid insurer’s aligned Medicare Advantage plan, they can remain in their MMC/HARP plan.
Consumers with Medicaid on NYSoH who become Medicare eligible will be automatically enrolled into a MSP for Part B premium payment. This typically takes effect the month following Medicare eligibility (i.e., for someone whose Medicare is effective August 1, their MSP would be effective September).
