New York nursing home custodial care Medicaid eligibility requirements

Avoid claim denials and payment recoupment by ensuring members’ eligibility for long-term care

As a reminder, New York nursing home facilities must submit signed 2159i and 3559 forms to the Human Resources Administration (HRA) or the Local Department of Social Services (LDSS) within 90 days of a member’s placement into long-term care. Failure to submit the forms may result in denied authorization extensions.

While the HRA or LDSS reviews a member’s eligibility for Medicaid, UnitedHealthcare Community Plan of New York will continue to reimburse the facilities for long-term services and supports (LTSS) claims. If the member’s application is incomplete or they’re found ineligible for LTSS care, payments made to the nursing home will be recouped.