New York Medicaid

Medicaid is a government health insurance program that helps people with limited income pay for health care. Ohio offers different Medicaid programs to meet the needs of different groups of people, including older adults, people with disabilities, and families.

What does New York Medicaid cover?

New York Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)

• Inpatient and outpatient hospital services

• Early and periodic screening, diagnostic, and treatment services

• Preventive care (e.g., vaccinations)

• Lab tests and X-rays

• Dialysis services

• Mental health services

• Substance use treatment

• Rural health clinic services

• Medical transportation

• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy

• Home- and community-based care

• Case management

• Prescription drugs

• Dental and vision care

• Hearing services

• Podiatry services

• Hospice care

Since the program serves those with limited income and resources, people with New York Medicaid pay few to no out-of-pocket costs for their benefits. To get coverage once you are enrolled, you must go to health care providers that take part in the New York Medicaid program.

In New York, Medicaid is run by the New York State Department of Health. Call the New York State Medicaid Helpline at 1-800-541-2831 to learn more about the coverages provided.

How do I know if I qualify for Medicaid in New York?

In general, to be eligible for Medicaid, you must:

• Be a New York resident

• Be a U.S. citizen or a qualified non-citizen

• Meet the income and/or asset limit for your coverage group

What are the different Medicaid programs in New York?

You may be able to get health coverage from one of the programs below.

Nursing Home Medicaid

If you need long-term care in a nursing home, New York Medicaid may help pay for your care through its Nursing Home Medicaid program. In addition to room and board, Medicaid may cover nursing care, rehabilitation, prescription drugs, medical equipment and supplies, social services, and some personal care items, such as hair care and clothing.

Community Based Long-Term Care

New York's Medicaid Community-Based Long-Term Care program helps you stay in your own home instead of moving to a nursing home. Depending on your needs, the program may pay for help with everyday tasks such as bathing, dressing, and grooming, as well as housekeeping, laundry, shopping, and errands. It may also provide home-delivered meals or help with preparing meals.

Medicaid Buy-In Program for Working People with Disabilities

The New York Medicaid Buy-In Program for Working People with Disabilities helps people with disabilities keep their Medicaid coverage while they work. If you are age 16 to 64, have a disability, and have a job, you may qualify even if your income is too high for regular Medicaid. The program covers many health care services, including doctor visits, hospital care, and prescription medicine. It allows you to continue working without losing your health insurance.

Excess Income (Medicaid Spend-down) Program

This program lets you get New York Medicaid even if your income is higher than Medicaid program guidelines. It works by letting you spend down your income so that you meet Medicaid income limits. The spend-down amount is the amount of income that is over the Medicaid limit. This amount is different for each person.

To get Medicaid benefits, you must send in current paid or unpaid medical bills equal to or greater than your monthly spend-down amount. Once your medical bills reach this amount, you will get Medicaid coverage for the rest of the calendar month. While using Medicaid to pay for your medical expenses, be sure to use a health care provider who takes part in the Medicaid program.

Some examples of medical expenses you can use include:

• Unpaid medical bills that have not been used to meet the share of cost before

• Health insurance premiums

• Medical bills you paid within the last three months

• Medical bills that will not be paid by health insurance (or any other source)

• Co-pays for medical bills

• Medical services prescribed by your doctor

• Transportation by ambulance, bus, or taxi to get health care services

Some examples of medical expenses you cannot use include:

• Premiums for insurance policies that pay you for hospitalization

• Over-the-counter medical supplies (like cold medicine or bandages)

Note: Certain health care providers do not accept New York Medicaid or the Excess Income Program. Be sure to tell your provider that you take part in the Excess Income Program before making an appointment.

How do Medicare and Medicaid work together?

If you get Medicare, you may also be able to get help from New York Medicaid. This is called being “dual eligible.” Medicaid pays for some services not covered by Medicare such as eyeglasses, hearing aids, and dental care.

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums.

Depending on the level of New York Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments

• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.

• You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, call 1-800-MEDICARE (1-800-633-4227; TTY: 1-877-486-2048) or call New York Health Insurance Information, Counseling, and Assistance (HIICAP) at 1-800-701-0501.

How do I prepare to apply for Medicaid in New York?

When you apply for Medicaid in New York, you’ll be asked for important information to help determine if you qualify for benefits.

Before you start, gather some basic information to make things easier:

• A document that shows your age, such as your birth certificate or driver’s license

• Your Social Security card

• Pay stubs for anyone in your household who has earned income

• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)

• Information about your financial assets, such as bank account or investment account statements

How do I apply for Medicaid in New York?

If you’re age 65 or older or living with a disability, the quickest and easiest way to apply for Medicaid in New York is online through the ACCESS HRA website. All your personal information is kept 100% confidential and protected by special security technology.

Apply on Access HRA

When you arrive on the site, look under "Medicaid," and click "Apply." You will have to create an account first if you don't have one. To register, click "Create Account." If you already have an account, you can login to start your application or pick up where you left off.

Note: If you’re under 65, you can apply for New York Medicaid through the NY State of Health website.

Apply by Phone

Call an Enrollment Counselor at 1-347-396-4705 or call the HRA Medicaid Helpline at 1-888-692-6116. You can also make an appointment with a Facilitated Enroller.

Apply in Person

Download and complete the application form and follow the instructions to mail it. You can also visit your local Medicaid office. Find your location here.

How can I get help with my New York Medicaid application?

• Call an Enrollment Counselor at 1-347-396-4705 or call the HRA Medicaid Helpline at 1-888-692-6116.

• Make an appointment with a Facilitated Enroller.

• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.

NCOA also has a HelpLine you can call to get free support. Call [1-800-794-6559](tel:+18007946559) anytime Monday–Friday, from 8 a.m. to 7 p.m. EST.