2017 General Information System Messages

• GIS 17 MA/001 – Change of Enrollee Address – Template Letter for Plans
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  • Change of Enrollee Address – Template Letter for Plans (PDF)
• GIS 17 MA/002 – Social Security Number for Non–Citizens
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  • Social Security Number Attestation Form (PDF)
• GIS 17 MA/003 – Voluntary Repayments for Health Insurance Premium Payments Agreement
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  • Attachment I – Voluntary Repayment Agreement, Attachment II – Voluntary Repayment Agreement Cover Letter (PDF)
• GIS 17 MA/004: Clarification of Presumptive Eligibility Programs and Introduction of Revised Forms
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  • Attachment I - DOH-5224, Medicaid Presumptive Eligibility for Pregnant Women Screening Form (PDF)
  • Attachment II - DOH–4441, Medicaid Presumptive Eligibility for Children Screening Form (PDF)
• GIS 17 MA/005: Federal Poverty Levels
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  • Attachment I - NEW YORK STATE INCOME AND RESOURCE STANDARDS FOR NON-MAGI POPULATION (PDF)
  • Attachment II - NON-MAGI POPULATION (PDF)
  • Attachment III -New York State Income Standards for MAGI Population (PDF)
  • Attachment IV - MAGI POPULATION (PDF)
  • Attachment VI - REDUCTION FACTORS FOR CALCULATING MEDICAID ELIGIBILITY UNDER PICKLE AMENDMENT (PDF)
• GIS 17 MA/006: Consumer Directed Personal Assistance Program (CDPAP) Provided Out of State
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• GIS 17 MA/007: Income Attestation at Renewal - Reminder
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  • Attachment - Income Attestation at Renewal: Currently Enrolled in Medicaid
• GIS 17 MA/008: Policy Change for Trusts Established for Disabled Individuals Under Age 65
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• GIS 17 MA/009: Approval of 1915(c) Home and Community Based Services Care at Home(CAH) I/II Waiver Program and Application
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• GIS 17 MA/010: Approval of 1915(c) Home and Community Based Services Care at Home(CAH) I/II Waiver Program Process and Enrollment
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  • Attachment -Home and Community Based Services Care at Home(CAH) I/II Waiver Program Process and Enrollment
• GIS 17 MA/011: Treatment of Federal Income Tax Refunds and Advanced Payments
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• GIS 17 MA/012: Restriction/Exception Code 83 Alcohol and Substance Abuse
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• GIS 17 MA/013: Requirements for Participation in OPWDD Home and Community Based Services waivers
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• GIS 17 MA/014: Changes to Express Lane Eligibility Process
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• GIS 17 MA/015: Out-of-State Former Foster Care
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• GIS 17 MA/016: 2017 Update to the Actuarial Life Expectancy Table
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  • Attachment - 2017 Life Expectancy Table
• GIS 17 MA/017: Introduction to Form DOH-5247 - Medicaid Authorized Representative Designation/Change Request
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  • Attachment - English
  • Attachment - Spanish
  • Attachment - Haitian Creole
  • Attachment - Italian
  • Attachment - Korean
  • Attachment - Russian
  • Attachment - Chinese
• GIS 17 MA/018: Fair Hearing Language Informing Consumers of theAvailability of Specific Policy MaterialsNeeded to Prepare for Fair Hearings
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  • Attachment - List of Revised Manual Eligibility Notices
• GIS 17 MA/019: Medicaid Regional Rates for Calculating Transfer Penalty Periods for 2018
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• GIS 17 MA/020 - 2018 Medicaid Levels and Other Updates
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  • Attachment I - New York State Income and Resource Standards for NON-MAGI Population Effective January 1, 2018 (PDF)
  • Attachment II - NON-MAGI Population (PDF)
  • Attachment III - Reduction Factors for Calculating Medicaid Eligibility Under the Pickle Amendment (PDF)