Medicare Savings Program denied, or no answer after 45 days? What to do in New York

Every Notice of Action should say what was decided, why, and the date of the notice. Circle the date. The 60-day clock for a fair hearing starts there, not on the day you opened the letter.

Common reasons, and what they usually mean:

• "Failure to provide documentation" means a proof was missing or unreadable. This is the easiest to fix.
• "Income exceeds the limit" means their math put you over. Check it. In 2026, New York's limit for QMB is $1,836 a month for one person and $2,489 for a couple, plus a $20 income disregard. For QI it is $2,474 and $3,355, plus the $20 disregard. Health insurance premiums you pay can lower countable income, so a missing premium bill can push you over on paper.
• "Not a resident" or identity problems usually mean a proof of address or ID was missing or too old. Address proof should be dated within six months of when you signed.
• "Not entitled to Medicare Part A" matters for QI, which requires Part A.

Reapplying and asking for a fair hearing are not either/or. You can do both. A new application can get you approved going forward, while the hearing can fix the old decision.

The state's standard Medicaid notice lists four ways to ask. Have your notice in front of you.

1. Phone: 1-800-342-3334 (statewide, toll-free).
2. Fax: send a copy of your notice to (518) 473-6735.
3. Online: the fair hearing request form on otda.ny.gov/hearings.
4. Mail: send a copy of your notice to Fair Hearing Section, New York State Office of Temporary and Disability Assistance, P.O. Box 1930, Albany, NY 12201. Keep a copy.

Say in one or two sentences why the decision is wrong, for example: "My income was counted too high. They did not subtract my Medigap premium." Write down the date and any confirmation number.

• The state sends a notice with the time and place of the hearing.
• You can bring a relative, friend, advocate, or lawyer, or speak for yourself.
• Gather the notice, your application copy, your Social Security award letter, pension statements, and premium bills.
• Ask the agency for your case file before the hearing so you can see how they did the math.
• If you win, the decision tells the agency to fix your case. Keep the decision letter.

If you get a notice that your MSP will stop, the notice tells you the effective date. The state notice says that if you ask for a fair hearing before that date, your benefits can stay the same until the decision. This is called aid continuing. Missing a renewal is a common reason for closings, so check whether you returned your renewal form.

Since October 1, 2026, New York's notice GIS 26 MA/14 limits the Medicare Savings Program to U.S. citizens and nationals, green-card holders who have finished or are exempt from the 5-year wait, Cuban-Haitian entrants, and COFA migrants. There is no state-only MSP for anyone else.

• If the office has your status wrong, for example you now have a green card, or you are past the 5-year wait, send copies of your current document and ask for a fair hearing by the deadline on the notice.
• If the notice is right, a fair hearing cannot restore MSP. Our guide to losing MSP because of immigration status explains what happens to your Part B premium, Medicaid, and Medicare.
• Free help: HIICAP at 1-800-701-0501 for Medicare questions, and the New York State New Americans Hotline at 1-800-566-7636 for immigration questions and free legal referrals.

• Waiting too long. The 60 days run from the date on the notice.
• Calling the local office number on the notice to ask for a hearing. The notice says that number is only for a conference, not a fair hearing.
• Not sending the proof that would have fixed it.
• Assuming a denial means you can never apply again. You can reapply any time.