NYS Medicaid Buy-In Implementation Plan: No Premiums till April 2004

April 2003

At a Capitol meeting yesterday of groups called to provide outreach, education and client representation in support of the implementation of the Medicaid Buy-In, Governor Pataki's Buy-In implementation plans were announced as follows:

· Education and outreach to New Yorkers with disabilities and the various provider and governmental groups that serve or support them will be quickly developed and available by mid-Spring to support the Medicaid Buy-In program's implementation date of July 1, 2003.

· New Yorkers with disabilities will be able to go to their local County Social Services offices on July 1 and apply for the Medicaid Buy-In.

· In recognition of staffing shortages and workload issues at many Local Departments of Social Services, local DSS offices will be playing a more limited role during the first 9-12 months of the program's 'interim' implementation (July 1, 2003 to April 1, 2004). During that period, local social services staff will be responsible for taking applications and , upon ensuring that each application has been completely filled out and that the necessary supporting documentation has been attached, send it on to the State Department of Health's Bureau of Medicaid Eligibility Operations.

· Interagency state staff comprised largely of DOH, OMH and OMRDD personnel will then, during this 'interim' period of July 1, 2003 and April 2004, process each application for the Buy-In.

· Applications must demonstrate the applicant has both a job and a verifiable disability (SSI and SSDI status will be adequate, VA or Workers Compensation disability status will require more documentation). State staff will then make a disability determination, issue a letter verifying the applicant's acceptance or denial into the Medicaid Buy-In program and then enter eligible individuals' information into the appropriate state and local databases.

· This process will typically take 45 days for most applications, up to 90 for those needing additional corroboration.

· Individuals who apply in July and are successfully enrolled into the Medicaid Buy-In program during the 1-3 months of expected processing time can expect that Medicaid will cover their medical expenses retroactively back to the July 1 start date.

· Due to delays in the establishment of an automated premium collection and tracking system, the Governor has provided for a moratorium on premium payments until April 2004, when the system is expected to be operational.

· Local Social Service Departments will be taking over full responsibility for taking and processing applications and enrolling individuals into the Medicaid Buy-In program on April 2004. At that time, Buy-In enrollees earning between 150-250% of the Federal Poverty Level will be expected to begin paying premiums to retain their Medicaid.