DOH Provides Details on Medicaid Eligibility Process for Undocumented Nursing Home Residents
(Nov. 26, 2024) A Department of Health (DOH) Dear Administrator Letter (DAL) issued on Nov. 25th provided new details on the Medicaid application process for undocumented older adults seeking coverage of nursing home care. Legislation implemented in January 2024 authorized Medicaid coverage of undocumented non-citizens, age 65 and over, through mainstream Medicaid managed care plans. Accordingly, qualifying undocumented non-citizens are entitled to nursing home benefits, if they are determined financially eligible under standard Medicaid rules, once they are enrolled in a managed care plan, and the plan has approved the placement.
Both post-acute and long-term nursing home care are covered benefits under the legislation. Consumers seeking Medicaid coverage for a short stay do not need a chronic care eligibility determination by DOH. Long-stay nursing home benefits, however, require chronic care eligibility, including consideration of the 60-month transfer of assets lookback period and the application of a transfer of assets penalty period, as applicable.
Nursing homes assisting undocumented older adults seeking Medicaid coverage of a permanent nursing home placement must submit (at a minimum) the following documentation:
- DOH-4220 “Access NY” (for consumers without any existing Medicaid coverage);
- DOH-5178A “Supplement A”;
- Local Department of Social Services (LDSS)-3559 “Residential Health Care Facility Report of Medicaid Recipient Admission/Discharge/Re-Admission/Change in Status” or MAP-2159i “Notice of Permanent Placement Medicaid Managed Care” (NYC);
- DOH-5147 “Submission of Application on Behalf of Applicant” or MAP-5044 “Facility Submission of Application on Behalf of Consumer” (NYC); and
- Any documentation or information provided by the consumer to determine financial eligibility.
If the consumer does not have a Social Security Number (SSN), no SSN would be entered on their application materials.
Facilities assisting consumers residing outside of NYC with an application for long-term nursing home care should send all required documentation to the appropriate LDSS. The LDSS will forward any documentation to DOH for an eligibility determination. Facilities assisting NYC residents with applying for long-term nursing home benefits should fax all required documentation to DOH at 518-408-9792.
Contact: Karen Lipson, klipson@leadingageny.org