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Email Benefit Update May 2007
- Changes to EPIC
- MEDICAID MANAGED CARE: SSI Related Category with Serious Mental Illness
- "People First" Coordinated Care Listening Forums
- NYS Expanding Child Health Plus
- NYC Council introduces the "Safe Housing Act"
- Housing Stability Plus (HSP) News
- Status on Rivera vs. Bane
- Community Resources
Changes to EPIC
Effective July 1, 2007, New York State passed legislation requiring EPIC enrollees to join a Medicare prescription drug plan as a condition of EPIC eligibility unless they meet exception criteria. EPIC will facilitate the enrollment of each member in a basic Medicare drug plan. EPIC will use records of each member’s drug utilization and preferred pharmacy to select the best basic plan for that member.
Current EPIC members will be enrolled in a plan by July 1, 2007. Members will receive a facilitated enrollment letter indicating which Part D plan they were enrolled in along with an explanation of the changes. If members are not satisfied with the plan EPIC has chosen they can switch plans by contacting EPIC within the specified time frame indicated in their enrollment letter. EPIC will then facilitate the enrollment of the member into the new plan the member has selected.
If EPIC members are facilitated into a plan as described above, members will have another opportunity to switch plans through a Special Enrollment Period which they can use anytime throughout the year. More information on the facilitated enrollment process for members joining EPIC after July 1, 2007 will be forthcoming.
There are some exceptions to mandatory enrollment to ensure that members are not disadvantaged by enrolling into Medicare drug plans. The exceptions are:
- Members who do not qualify or are not enrolled in Medicare Part A or Part B;
- Deductible enrollees who do not meet their EPIC deductible;
- Members in Medicare Advantage (MA) only plans that do not offer a cost-effective Part D option without reducing other medical benefits;
- Members with employer-based drug coverage that would be jeopardized if the member enrolled in a Medicare drug plan.
EPIC will provide Part D premium assistance to all enrollees so no one will be disadvantaged by this new requirement.
- EPIC Fee Plan
For members in the Fee Plan, EPIC will pay the monthly Part D premium for any PDP or MA-PD up to the benchmark amount ($24.45 in 2007). Members who have selected plans with more expensive premiums will be billed for the difference. Fee Plan members will be responsible for paying their annual or quarterly EPIC fee, unless they receive full Extra Help, in which case, EPIC will continue to waive the EPIC fee.
- EPIC Deductible Plan
Deductible Plan members will receive an annual credit toward their EPIC deductible, reducing their deductible. In 2007, EPIC members will receive a credit that is equal to $24.45 times the number of months left in their EPIC coverage year. This credit will reduce their annual EPIC deductible. Subsequently, the credit will be based on the total yearly cost of Part D premiums (the monthly benchmark premium times twelve months
MEDICAID MANAGED CARE: SSI Related Category with Serious Mental Illness
In November of 2005, SSI and SSI-related recipients were no longer exempt from mandatory enrollment in a Medicaid managed care plan. Some individuals who were in the SSI-related category continued to be exempt under one of the other exemption categories. Some of these individuals were exempt because of a serious mental illness. Now effective March 1, 2007, no new mental health exemptions will be granted to those with SSI or in the SSI-related category. Those with serious mental illness in receipt of SSI or SSI-related are no longer considered exempt from mandatory enrollment.
These individuals will be receiving an enrollment packet from NYC Medicaid CHOICE and they must select and enroll in a health plan within 90 days. Notices were sent out in March and enrollment packets will be sent out April through August 2007 throughout the 5 boroughs. These individuals may qualify for an exemption under another exemption category.
Individuals with serious mental illness who are not on SSI or who are eligible for Medicaid under the TANF or Safety Net categories may still request a mental health exemption from NYC Medicaid CHOICE. Clients can contact NYC Medicaid CHOICE for an exemption or for more information at: (800) 505-5678.
"People First" Coordinated Care Listening Forums
The Governor has announced a series of listening forums to obtain input from individuals and providers who use multiple services in the areas of health care, addiction, mental health, and developmental disabilities and their families regarding their experiences. The goal is to obtain insight on how to improve quality and outcomes, as well as coordinate support for people who have needs across multiple systems. In each different area, the commissioners in the service areas will be seeking feedback from local communities on access to resources, quality of care, interagency collaboration and coordination of care.
Forums will be held statewide at the following areas and dates:
| New Paltz | New York City | Buffalo | Syracuse | Plattsburgh |
| 5/14/07 | 6/6/07 | 6/19/07 | 6/20/07 | 7/13/07 |
Exact locations to be announced on the following websites:
Space is limited. Seating will be on a first come, first served basis. Forums will be broadcast live at each of the following agencies websites above.
Visit NYS’s website for more information: www.ny.gov/governor/press/0426073.html.
NYS Expanding Child Health Plus
The state will be expanding its Child Health Plus (CHP) program beginning September 1, 2007 to include families making up to 400% of the federal poverty level. This would make the income guideline for a family of 4, $6,884. Depending on the household’s income, a family may or may not pay a premium for health coverage under CHP.
Child Health Plus is a Federal and New York State subsidized health insurance program that offers free or low cost health insurance to uninsured children from birth to age 19 who are not eligible for Medicaid. Children who are undocumented can receive health insurance with CHP. Recipients of CHP access care through a managed care plan. For more information call the Child Health Plus Hotline (800) 698-4543.
NYC Council introduces the "Safe Housing Act"
In April the city council introduced legislation (Int. 0561-2007) to preserve housing and make vital repairs in the City’s worst buildings. Under the Safe Housing Act, every year the city would identify 200 buildings with the worst housing code violations and target them for aggressive inspection, follow-up, and comprehensive repairs. The City’s Department of Housing Preservation and Development (HPD) would facilitate and monitor these City-mandated improvements.
Offending landlords will be notified by HPD to correct violations and make all required repairs from top to bottom within a four month time period. If building owners do not make those repairs, HPD would step in and make comprehensive repairs. Owners would then be required to reimburse the City for the cost of repairs. HPD would also address the major underlying causes for unsafe conditions in the building and would continue to monitor these building owners for one year. Visit the City Council’s website at www.nyccouncil.info for more information and/or to track the progress (use the "Search for Legislation by Number" feature.)
Housing Stability Plus (HSP) News
Housing Stability Plus (HSP) has posed many problems for both the administration and recipients from it’s inception. The Coalition for the Homeless released a report "Homeless Families at Risk" highlighting the issues with HSP (click here for the report).
Recently the Department of Homeless Services (DHS) announced the Work Advantage program (or Advantage program). Work Advantage will eventually replace HSP and provide rental assistance that is not tied to the continued receipt of Public Assistance. It is a one year rental subsidy with a second year extension available for those who meet continuation criteria. While receiving the rental assistance, participants will be expected to work and are encouraged to save their earnings. These savings will be doubled so that when the rental assistance ends, families have additional means of support.
In addition, this program includes access to a comprehensive package which will support work and economic stability including jobs, workforce development, and transitional benefits such as food stamps, Medicaid and child care. HRA will also work with Work Advantage clients through welfare to work programs by providing job training, search and placement support.
The program is open to families and singles who have been in a shelter for 90 days and employed at least 20 hours a week with income below 150% of the Federal Poverty level.
For more information visit the NYC Department of Homeless services at: www.nyc.gov/html/dhs/html/rent/wrkAdvnt_pg3.shtml
Status of Rivera v. Bane
Under the stipulation in Rivera v. Bane, the Human Resources Administration (HRA) must provide a recipient and his/her representative with a copy of the documents it intends to introduce into evidence at the fair hearing and any documents the recipient and/or his/her representative might specifically request from the case record. The Rivera stipulation expired on February 22, 2007. However, counsel for Rivera are still involved in settlement negotiations with the State and City to extend the stipulation and for enforcement of the monitoring provisions. While the motion is pending, the stipulation continues to be in effect. PBRC will provide an update as this continues.
To request the evidence packets:
- For Public Assistance and Food Stamps:
City of New York Human Resources Administration, Division of Fair Hearings
Fair Hearing Evidence Packet Unit
14 Boerum Place, 6th floor
Brooklyn, NY 11201
(718) 722-5012; (718) 722-5018 (fax)
- For Medicaid:
City of New York Human Resources Administration, Division of Fair Hearings
330 West 34th Street
New York, NY 10001
(212) 630-0996; (212) 630-9897 (fax)
Community Resources
Resources for Children with Special Needs, INC.
The Family Support Project provides direct educational advocacy for children ages 5- 21 residing in Manhattan with developmental disabilities. The project provides assistance on obtaining appropriate education services, working with the public school system and special educational services, entitlements, and other program options. Call 212-677-4650 for more information.
HPD's website now allows New Yorkers to check status of housing maintenance complaints to 311
The New York City Department of Housing Preservation and Development (HPD) launched a new website feature allowing New Yorkers to check the status of housing maintenance complaints reported to the 311 Customer Service Center. Through HPD's Web site at www.nyc.gov/hpd. Customers enter their 311 complaint number to check progress on their complaint from the time they call 311 until an inspector comes to their apartment to verify the complaint and issue a violation, if warranted. The 311 complaint number is provided by the 311 Call Center Representative when a tenant first reports an apartment maintenance problem and it is also on the letter sent in the mail to the tenant by HPD confirming receipt of the complaint.
Legal Aid Society Health Law Unit
The Health Law Unit (HLU) assists clients and advocates on a range of navigational issues within public health programs. These issues include, barriers to enrollment and retention of benefits denials of health care services, coordination of benefits, access to care for uninsured persons, immigrant access to health care, reduction of medical debt etc.
Contact:
- Health Law Hotline (New York City): (212) 577-3575
- Health Law Hotline (Upstate): (888) 500-2455
Part D Appeals Manual
The Medicare Rights Center has created a free, comprehensive, easy-to-understand Part D appeals manual for advocates who help people with Medicare get the drugs they need: “Medicare Part D Appeals: An advocate’s manual to navigating the Medicare private drug plan appeals process.” This 25-page manual offers a complete overview of the entire appeals process, real-life case examples from our Client Services department, a glossary of important Part D appeals terms, a sample appeals protocol for advocates, and links to important resources and documents. You must register to use the manual, registration is FREE go to: www.medicarerights.org/appealsmanual.html.