What is Medicaid? Medicaid is a program for New Yorkers who can’t afford to pay for medical care.
How do I know if I qualify for Medicaid?
You may be covered by Medicaid if:
You have high medical bills.
You receive Supplemental Security Income (SSI).
You meet certain financial requirements.
For more details, use the ACCESS NY Public Health Insurance Eligibility Screening Tool to see which public health insurance programs you and your family may be eligible
What do I need to apply for Medicaid?
If you are a U.S. citizen (born in the U.S. or one of its territories) and provide a valid Social Security Number (SSN), a match with Social Security Administration (SSA) will verify your SSN, date of birth/age and U.S citizenship. If SSA verifies this information,no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen.
You will need proof of naturalization (e.g., Naturalization Certificate (N-550 or N-570) or a U.S. passport).Proof of age (if not verified by SSA), like a birth certificate Proof of citizenship or immigration status*Four weeks of recent paycheck stubs (if you are working)Proof of your income from sources like Social Security, Supplemental Security Income (SSI), Veteran’s Benefits (VA), retirementUnemployment Insurance Benefits (UIB), Child Support payments
If you or anyone who lives with you is 65 years old or older, certified blind or disabled, you need to provide information on bank accounts, insurance policies and other resources.
Proof of where you live, like a rent receipt, landlord statement, mortgage statement, or envelope from mail you received recently
Insurance benefit card or the policy (if you have any other health insurance)Medicare Benefit Card (the red, white and blue 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 Medicaid eligibility requirements
What is a Medicaid managed care program?
Enrollment in a Medicaid managed care program through a Health Maintenance Organization (HMO), clinic, hospital, or physician group is available at any local department of social services. You may be required to join a managed care plan. When you join a managed care program, you will choose a personal doctor who will be responsible for making sure all your health care needs are met. The doctor will send you to someone else if you need more help than the doctor can provide.
What does managed care cover?
Managed care covers most of the benefits recipients will use, including all preventive and primary care, inpatient care, and eye care. People in managed care plans use their Medicaid benefit card to get those services that the plan does not cover.
Do I have to join a managed care plan?
In many counties you can join a plan if there is one available and you want to. However, there are some counties where families will have to join a plan. In these counties there are some individuals who don’t have to join. Please check with your local social services department to see if you have to join a plan.
Of 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 should 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.
The following questions are only for people who are 65 years of age or older, certified blind, certified disabled, or in need of care in a nursing home. These individuals have a resource test.
Medicaid Redesign: Uniform Assessment System for Long-Term Care in New York State
The New York State Department of Health, Division of Long Term Care (DLTC) is in the midst of developing and implementing the Uniform Assessment System – New York (UAS-NY). The UAS-NY is planned to be a comprehensive, web-based system. Initially, the UAS-NY will focus on implementing the UAS-Community Health Assessment (UAS-CHA). The UAS-NY will have the capability to expand in the future.
The development and implementation of the UAS-NY will occur in four phases:
pilot testing the UAS-NY and the UAS-CHA (projected June through August 2012)
statewide implementation (projected to begin September 2012)