Glossary

This glossary provides definitions for key words used on this website. Review the entire list or click on an alphabet button to browse shorter lists by letter.

  • AC

    Aid Continuing. When Medicaid or a managed care plan decides to stop providing or give less of a covered service, you have the right to keep the services the same while you appeal that decision.
  • ADL

    Activities of Daily Living are the routine things people do every day in caring for and using their bodies. Here are some examples of ADLs that some people need help to do:
    • Taking a shower or bath
    • Getting dressed
    • Getting ready for bed
    • Grooming
    • Preparing meals
    • Taking medications
    • Getting around, whether by walking or using assistive devices like a wheelchair, cane or walker
    • Transferring, which means getting up from a chair or from the bed
    • Using the bathroom
    • Light housekeeping
    • Grocery shopping
    • Paying the bills
    • Doing laundry
  • CDPAP

    Consumer Directed Personal Assistance Program is a type of Medicaid-covered home care that allows Medicaid recipients to recruit, hire, train, supervise and terminate their own personal assistants. Under CDPA, people who need long term care have much greater control over their own care than with traditional home care. CDPA aides are also allowed to perform skilled tasks that would otherwise need to be done by a nurse.
  • DOH

    The New York State Department of Health is the single state agency responsible for running New York's Medicaid program. DOH selects, contracts, pays, and oversees all Medicaid managed care plans, including all types of MLTC plan. ICAN is funded by DOH.
  • dual eligible

    Dual eligible means someone who has both Medicare and Medicaid health insurance.  If you are a dual eligible, then Medicare is your primary insurance.  This means that Medicare pays most or all of the cost for your doctors, hospitals and other Medicare-covered healthcare.  Medicaid is your secondary insurance.  This means that Medicaid can pay for the portion of your medical costs not paid by Medicare.  Medicaid also pays for some healthcare services that Medicare does not cover, such as long term care.  There are some special types of health insurance that simplify things for dual eligibles, such as FIDA, MAP and PACE.
  • FH

    Fair Hearing.  A type of appeal in the Medicaid program. Whenever the LDSS or a managed care plan makes a decision about a person's Medicaid benefits, the person has the right to ask for a fair hearing.  The person goes before a State hearing officer in person, and can tell them why they think the decision about their Medicaid was wrong.  They can give written evidence, oral testimony, and make legal arguments.
  • Fully Integrated Duals Advantage (FIDA)

    FIDA stands for Fully Integrated Duals Advantage.  It is a new type of health insurance for people with both Medicare and Medicaid.  FIDA is a way to get all of your medical care through one plan.  A FIDA plan covers all of the same services covered by Medicare and Medicaid, plus more services that are not usually covered.  There are no deductibles or copayments in FIDA.  Your FIDA plan would create a team of people to help you get the services you need from your plan. This care planning team would include you, your doctor, and anyone else you want to help.
  • health insurance

    Health insurance is a system that helps you pay for medical care.  It is very expensive to pay for doctors, hospitals, and medications.  If you get sick or injured, your medical costs could be huge.  Health insurance is a way to protect yourself from large medical expenses.  Most health insurance is provided through private insurance companies.  You pay a monthly premium to the company, and in return they are responsible for paying for any medical care you need.  Each health insurance company has a document that explains which types of medical care they will pay for.  Usually, you need to go to doctors, hospitals, and other providers who accept your insurance.  Most people get health insurance through their employers.  Usually the employer pays part of the premium, and the employee pays the rest.  Many people get health insurance through government programs like Medicare or Medicaid.  And still others buy individual policies, such as those available through the Marketplace.
  • LDSS

    The Local Department of Social Services is the division of county government that handles the Medicaid program for older adults and people with disabilities. This is where you apply for Medicaid. The LDSS also sends you your annual recertification packet. The LDSS for all of New York City is the NYC Human Resources Administration. You can find your LDSS here.
  • LTC

    Long term care means services that help you with your activities of daily living. For example, if you need help from another person to bathe and get dressed, you could get a home attendant to come to your home to help you. Home care is a type of long term care. If you go to an adult day care center for activities and meals, that is also a type of long term care. Most people in New York who need this kind of help can get it in their own homes. If you can't live safely in your own home, you can also receive long term care in a skilled nursing facility (also called a nursing home). Medicare doesn't pay for long term care; only for short stays in skilled nursing facilities or a few weeks of home health aide services. Medicaid does pay for long term care.
  • MAP

    Medicaid Advantage Plus is a type of managed long term care plan that includes both Medicare and Medicaid benefits. It is like a Medicare Advantage plan combined with a Medicaid-only MLTC plan. Age requirements vary among plans from 18+ to 65+. Unlike PACE, there is no center you need to go to for your doctors and other care.  
  • Medicaid

    The New York state public health insurance program for people with limited income. Medicaid provides free, comprehensive health insurance for over 5 million New Yorkers. Medicaid is also the primary source of coverage for long term care services, such as home care and nursing home care.
  • Medicare

    The national public health insurance program for people age 65 or older and people receiving Social Security Disability Insurance. Medicare covers doctors, hospitals, prescription drugs, and most medical care and treatments. You do not need to have low income to get Medicare. Medicare is not free, but there are programs that can reduce or eliminate the costs of Medicare. There are certain services that Medicare does not cover, including routine dental care and long term care services. You can have both Medicare and Medicaid if you qualify.
  • Medicare Advantage

    Medicare Advantage is a way to get your Medicare health insurance through a private managed care plan. Some Medicare beneficiaries choose to enroll in these plans, although they are not mandatory.  Most Medicare Advantage plans also include prescription drug coverage through Part D.
  • MLTC

    Managed Long Term Care is a type of Medicaid health insurance that covers long term care services for people who need help with their activities of daily living. There are four kinds of MLTC in New York: Medicaid MLTC, MAP, PACE and FIDA.
  • MMC

    Mainstream Medicaid Managed Care is the type of health insurance that most people with Medicaid in New York have.  Once you have been approved for Medicaid, you must choose a Medicaid managed care plan.  These are private health insurance companies that provide all of the health coverage available under Medicaid.  Once you are enrolled in an MMC plan, you will receive a card which you will use to access all of your medical care, including long term care.  There are only a few Medicaid services that you still would use your Medicaid card for.
  • MSP

    A Medicare Savings Program is a type of Medicaid benefit that helps pay some of the costs of Medicare health insurance for people with low income.  All MSPs pay for the Medicare Part B premium (currently $104.90/month).  One of the MSPs, QMB, also pays for Medicare deductibles and copayments.
  • NHTD

    The NHTD waiver uses Medicaid funding to provide supports and services to assist individuals with disabilities and seniors toward successful inclusion in the community. Waiver participants may come from a nursing facility (transition), or choose to participate in the waiver to prevent institutionalization (diversion). NHTD waiver participants are currently excluded from managed long term care. The special supports covered by the NHTD waiver are also covered by FIDA.
  • OTC

    Over-The-Counter - medical or healthcare items that can be bought at a pharmacy without a prescription from your doctor.  Examples include vitamins, cold medicine, and some personal care supplies.
  • PACE

    The Program of All-inclusive Care for the Elderly is a type of managed long term care that includes all Medicare and Medicaid covered services. You have to be at least 55 years old to join PACE. If you join a PACE, you must go to a center in your neighborhood to get most of your care. The PACE center includes doctors and nurses who coordinate your care, as well as adult day care, meals, and other services. PACE is not available everywhere in the State. But it is a great option for people who live near a PACE center.
  • PCA

    Personal Care Assistance is the most common type of Medicaid-covered home care services in New York. PCA is covered by all kinds of MLTC plan. The services are provided by a certified, trained paraprofessional, employed by a licensed agency and supervised by a nurse. Personal care aides can assist a person with their ADLs such as bathing, dressing, grooming, walking, and using the toilet. They can also help with shopping, chores, and light housekeeping.  Personal care aides cannot perform skilled tasks such as giving medication.
  • supplement

    If you have insurance that supplements Medicare, this means that it covers some or all of your medical costs not covered by Medicare.  Medicare covers most medical care, but sometimes charges deductibles or copayments.  With supplemental coverage, you would not have to pay these extra costs.  Some people supplement their Medicare coverage by purchasing a Medigap policy, which can cost $100-$300 per month.  Other people get supplemental coverage through their former employer or union.  And people who qualify for Medicaid can use Medicaid to supplement their Medicare coverage.
  • surplus

    The amount by which a person's monthly income exceeds the Medicaid income limit. Older adults and people with disabilities in New York can qualify for Medicaid health insurance even if their income is over the limit.  However, they must contribute toward the cost of their care by "spending-down" their excess income.  For most people receiving long term care, this means receiving a bill every month in the amount of their excess income.
  • TBI

    The TBI waiver is a special Medicaid program that helps people who have had a traumatic brain injury to live in the community setting of their choice. TBI waiver participants are currently excluded from managed long term care. The TBI services are also included in FIDA.
  • uninsured

    If you do not have any health insurance that pays for doctors and hospitals, then that means you are "uninsured." If you are uninsured and you get sick, you will usually have to pay the full cost of treatment out of your own pocket, which can be very expensive. The Affordable Care Act has created new options for you to get free or affordable health insurance. To find out more, visit New York's health insurance Marketplace, the New York State of Health.