Medicaid

Medicaid is a program for New Yorkers who can't afford to pay for medical care. You may be covered by Medicaid if:

  • You have high medical bills.
  • You receive Supplemental Security Income (SSI).
  • You meet certain income, resource, age, or disability requirements.

You can apply for Medicaid in any one of the following ways: Write, phone, or go to your local department of social services.

In New York City, contact the Human Resources Administration by calling (718) 557-1399. Residents of the five boroughs of New York City may call toll free at 1-877-472-8411.

Pregnant women and children can apply at many clinics, hospitals, and Prenatal Care Assistance Program (PCAP) offices. Call your local department of social services to find out where you can apply.

If you are in a facility operated by the New York State Office of Mental Health, contact the patient resource office.

If you are in a facility certified by the New York State Office of Mental Retardation and Developmental Disabilities, contact the revenue and reimbursement office.

Coverage

In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan.

  • smoking cessation agents
  • treatment and preventive health and dental care (doctors and dentists)
  • hospital inpatient and outpatient services
  • laboratory and X-ray services
  • care in a nursing home
  • care through home health agencies and personal care
  • treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
  • family planning services
  • early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
  • medicine, supplies, medical equipment, and appliances (wheelchairs, etc.)
  • clinic services
  • transportation to medical appointments, including public transportation and car mileage
  • emergency ambulance transportation to a hospital
  • prenatal care
  • some insurance and Medicare premiums
  • other health services

If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services.

For you to use your Benefit Identification Card for certain medical supplies, equipment, or services (e.g., wheelchair, orthopedic shoes, transportation), you or the person or facility that will provide the service must receive approval before the service can be provided (prior approval).

 

Interview and Peper requirement:
  • Proof of age, like a birth certificate
  • Proof of citizenship or alien status*
  • Recent paycheck stubs (if you are working)
  • Proof of your income from sources like Social Security, Supplemental Security Income (SSI), Veteran's Benefits (VA), retirement
  • Any bank books and insurance policies that you may have
  • Proof of where you live, like a rent receipt or landlord statement
  • Insurance benefit card or the policy (if you have any other health insurance)
  • Medicare Benefit Card

*NOTE: Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition. A doctor must certify that you are pregnant or had an emergency, and you must meet all other eligibility requirements.

 

Eligibelity Income Chart:

The chart below shows how much income you can receive in a month and the amount of resources you can retain and still qualify for Medicaid. The income and resource levels depend on the number of your family members who live with you.

2009 Income & Resource Levels*
Medicaid Standard for Singles
People, Couples without
Children & Low Income
Families		 Net Income for Families; and Individuals who
are Blind, Disabled or Age 65+		 Resource
Level
Annual Monthly Annual Monthly
1 $8,462 $706 $9200 $767 $13,800
2 $10,563 $881 $13,400 $1,117 $20,100
3 $12,568 $1,048 $15,410 $1,285 $23,115
4 $14,593 $1,217 $17,420 $1,452 $26,130
5 $16,686 $1,391 $19,430 $1,620 $29,145
6 $18,217 $1,519 $21,440 $1,787 $32,160
7 $19,829 $1,653 $23,450 $1,955 $35,175
8 $21,899 $1,825 $25,460 $2,122 $38,190
9 $23,088 $1,924 $27,470 $2,290 $41,205
10 $24,276 $2,023 $29,480 $2,458 $44,220
For each additional person, add: $95 $2,010 $168 $3,015

*Effective April 1, 2009

Income and Resource Levels are subject to yearly adjustments.

You may also own a home, a car, and personal property and still be eligible. The income and resources of legally responsible relatives in the household will also be counted.

 

If you make more money than the chart shows:

Some people can eligile for Medicaid even if he/she make more money than the chart shows. Pregnant women and children can have higher income levels and no resource limits.

Pregnant women, children, disabled persons, and others may also be eligible for Medicaid if their income and/or resources are above these levels and they have medical bills. Ask your Medicaid worker if you fit into one of these groups.

If an adult has too much income and/or resources and is not eligible for Medicaid, that person may be eligible for:

Expanded Income levels for Children and Pregnant Women
  • Infants to age one and pregnant women - 200% of the federal poverty level.
  • Children age 1 through 5 years - 133% of the federal poverty level.
  • Children age 6 through 18 years - 100% of the federal poverty level.
Monthly Income Effective January 1, 2009*
Number in Family 100% FPL** 133% FPL** 200% FPL**
1 $903 $1,201 $1,805
2 $1,215 $1,615 $2,429
3 $1,526 $2,030 $3,052
4 $1,838 $2,444 $3,675
5 $2,150 $2,859 $4,299
6 $2,461 $3,273 $4,922
7 $2,773 $3,688 $5,545
8 $3,085 $4,102 $6,169
For each additional person, add: +$312 +$415 +$624

* Income Levels are subject to yearly adjustments.

** FPL = Federal Poverty Level

If a child has too much income and is not eligible for Medicaid, the child may be eligible for Child Health Plus.

 

Special interest to persons with disabilities:

If you think you are disabled, and if you meet the criteria for disability included in the Social Security Act, you may be eligible for Medicaid.

If you believe you are disabled, you must furnish the local department of social services with medical evidence about your impairment(s).

It may be necessary for you to have further examinations and/or tests for the disability to be determined.

The cost of such examinations, consultations, and tests requested by the disability review team, if not otherwise covered, will be paid by the local social services agency.

NOTE: Persons who are denied for reasons of failure to meet the disability criteria are entitled to appeal the disability decision that led to the denial of their application. See the section of this page entitled "What are my rights?". Any person dissatisfied with the Fair Hearing decision of the New York State Office of Temporary and Disability Assistance may also appeal to the court system.

Local Department of Social Services

If you send an e-mail to Medicaid@health.state.ny.us please include your phone number so we can respond to you as quickly as possible.

Useful Links

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