powered by LeadingAge New York
  1. Home
  2. » Providers
  3. » Nursing Homes
  4. » DOH Notices and Policies
  5. » Update on Medicaid Coverage for Undocumented Non-Citizens Age 65+

Update on Medicaid Coverage for Undocumented Non-Citizens Age 65+

(Oct. 1, 2024) As of Jan. 1, 2024, undocumented non-citizens age 65 and over who are enrolled in a mainstream Medicaid managed care plan have access to all covered plan benefits, including long-term nursing home services. According to the August edition of the NYS Medicaid Update (released Sept. 26th), beneficiaries must be NYS residents who meet age and financial requirements and must be enrolled in a mainstream managed care plan in order to access Medicaid. They are not eligible to enroll in Managed Long Term Care (MLTC) plans, Programs of All-Inclusive Care for the Elderly (PACE programs), or other specialized Medicaid plans.

Prior to enrollment in a plan, consumers age 65 and older will have coverage code "38" in the Medicaid Eligibility Verification System (MEVS), indicating fee-for-service pharmacy and emergency only coverage. Once enrolled in a plan, they will be assigned coverage code "37" indicating that they are eligible for covered managed care plan benefits and pharmacy benefits through NYRx.

Facilities assisting non-NYC residents with applying for long-term nursing home benefits will continue to send all required application documentation to the appropriate Local Department of Social Services (LDSS). The LDSS will forward the documentation to the Department of Health (DOH) for an eligibility determination. Facilities assisting NYC residents with applying for long-term nursing home benefits should fax application documentation to DOH at 518-408-9792. Providers are encouraged to submit separate faxes for each applicant. Coverage for long-term nursing services will only be available once the consumer is enrolled in a plan and the plan has approved the placement.

Questions regarding this coverage expansion or eligibility may be directed to DOH here.

Contact: Karen Lipson, klipson@leadingageny.org