MEDICAID - 516-227-8000
Medicaid provides assistance to people who do not
have the means to pay for medical care. People
who are eligible include people in receipt of SSI (Supplemental
Security Income), Public
Assistance and those that meet the eligibility criteria.
Medicaid Pays for the Following:
- In-patient care in hospitals
- Out-patient care at hospitals
- Physician services
- Clinic services
- Pharmacy
- Skilled nursing home care
- Long Term Home Health Care
- Personal Care Aides
- Child Teen Health Program
- Mental Health
- Family planning
- Medical and health insurance Premium
- Non-emergency medical transportation
Medicaid FAQ
- January 2013: Important Notice to Medicaid Recipients Regarding Medicaid Coverage of Orthopedic Footwear and Compression Stockings
- What is Medicaid?
- What is the Medicaid State Plan?
- How do I know if I qualify for Medicaid?
- How do I apply for Medicaid?
- What do I need to apply for Medicaid?
- If I think I am eligible for Medicaid, should I cancel any other health insurance I might already have?
- How do I know if my income and resources qualify me for Medicaid?
- Can I be eligible for Medicaid even if I make more money than the chart shows?
- Can I get reimbursed for medical bills I paid?
- What is the Medicaid Excess Income Program?
- How long does it take to get Medicaid?
- What are my rights?
- How do I request a Fair Hearing?
- Will there be a lien (legal claim) placed on my estate (my assets) when I die?
- What health services are covered by Medicaid?
- Will I have to pay co-payments?
- What is a Medicaid managed care program?
- What does managed care cover?
- Do I have to join a managed care plan?
- Where can I find information on the new Medicare Part D Prescription Drug Program?
- What is the Medicaid Buy-In Program for Working People with Disabilities?
- I just want Family Planning Benefits. How do I apply?
- I want to know more about Family Health Plus.
- I want to know more about Child Health Plus.
For current Medicaid beneficiaries:
- What is a community spouse?
- I am a community spouse. Will I be allowed to keep any income or resources?
- How do I order a new Benefit card?
- How often do I have to renew?
- What do I have to do if I move from one county to another?
- I'm pregnant, how do I get a card for my baby?
- How do I report Medicaid Fraud?
For those subject to a resource test:
- What are resources?
- Can I still keep part of my income if I am in a nursing home (Residential Health Care Facility) or in an intermediate care facility for the developmentally disabled?
- What is a "look-back" period?
- What is a life estate? Will it make me ineligible?
- Am I allowed to have a pre-paid burial fund?
What if I do not agree with the agency’s decision regarding my eligibility?
If you think the agency’s decision is wrong, you can request a review of the decision. You can request a conference or ask for a State Fair Hearing. You can also do both of these things. Information on requesting either a conference or a Fair Hearing can be found on the written notice you received regarding your eligibility or by clicking on the link above “How do I request a Fair Hearing?”
The doctor’s office stated my Medicaid is not active. What do I do?
If you were told by your doctor’s office that your Medicaid is not active, you should first check with your Managed Care Plan to be sure you are no longer covered. If you do not have coverage with your plan, contact your DSS worker to find out the reason your Medicaid is not active. If your case was closed and you have received a notice advising you of the reason your Medicaid would close with an effective date, it may be necessary for you to reapply in order to restore your benefits.
Supplemental Security Income (SSI)
All SSI recipients are eligible for Medicaid automatically. The
district they reside in will be the district of financial
responsibility.
Supplemental Security Income (SSI)
is a federal assistance program for the aged (65 and
over), blind and disabled which is administered through
local Social
Security Offices. SSI beneficiaries are
automatically eligible for Medicaid and may be eligible
for Food
Stamps and Emergency
Assistance to Adults (EAA) as well as other
services through the local district offices. A small
number of SSI recipients, whose available income is less
than the applicable public assistance standard, may be
eligible for Safety
Net Assistance. Any Public
Assistance applicant who reasonably appears
to qualify for SSI, must apply for SSI and appeal any
negative determination made by the Social
Security Administration.
Questions about individual SSI claims should be addressed to the Social Security Administration at
1-800-772-1213 or you can view the Social Security web site for additional information.
Child Health Plus
New York State has a health insurance plan for children
under 19 years of age. The Medicaid program must
evaluate every child's eligibility for Medicaid (Child
Health Plus A), and those not eligible will be evaluated
by the provider for Child Health Plus B. The toll
free number for information on the program is 1-800-698-4543. This
health insurance plan is available throughout the state
and covers the following services:
- well-child care
- physical examinations
- immunizations
- diagnosis and treatment of illness and injury
- X-rays and lab tests
- outpatient surgery
- emergency care
- prescription drugs
- inpatient hospital medical or surgical care
- short-term therapeutic outpatient services (chemotherapy, hemodialysis)
- limited outpatient treatment for alcoholism and substance abuse and mental health
- dental care
- vision care
- speech and hearing
- durable medical equipment
Family Health Plus
In December 1999, Governor George
E. Pataki signed into law the Health Care Reform
Act of 2000 which expands quality health care coverage
to nearly one million uninsured New Yorkers under Family
Health Plus.
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What is Family Health Plus?
Family
Health Plus provides health coverage
to adults who do not have insurance through their employers,
but have income too high for Medicaid.
Who can join?
Parents and childless adults aged 19 through 64 are
eligible if they live in New York State, have no health
insurance coverage and have income at or below the eligibility
levels established by the New
York State Department of Health.
How much does it cost to join?
There is no cost to participate in Family Health Plus.
What services are covered?
- physician services;
- inpatient and outpatient health care;
- prescription drugs and smoking cessation products;
- lab tests and x-rays;
- vision, speech and hearing services;
- rehabilitative services (some limits apply);
- durable medical equipment;
- emergency room and emergency ambulance services;
- drug, alcohol and mental health treatment (some limits apply);
- diabetic supplies and equipment;
- radiation therapy, chemotherapy and hemodialysis; and
- dental services (if offered by the plan).
How is care provided?
Once applications are available, health care will be provided through managed care plans. Family Health Plus will do its best to help participants continue to see their current doctor.
How does a person enroll in Family Health Plus?
Enrollment facilitators and local social services district offices will help people enroll, answer their questions, and also help people choose a health plan.
How does a person know when to apply?
This website will be updated to let people know when they can apply for Family Health Plus. In addition, there will also be an advertising campaign.
Can a person drop health insurance to join this program?
No. Family Health Plus is a health care program for persons who do not already have health insurance.
If my children are in Child Health Plus, does that mean I'm eligible for Family Health Plus?
Not necessarily. Family Health Plus has maximum income levels depending on household size. Child Health Plus does not.
Will children who are in Child Health Plus have to transfer to Family Health Plus ?
No. Children will still be covered under the Child Health Plus program. Child Health Plus is a program for children, and Family Health Plus is a program for adults. Family Health Plus will do its best to help parents enroll in the same plan as their children.
What if an individual's income is too high for Family Health Plus?
You
may be eligible for the Healthy NY program. Please
contact Healthy NY at 1-866-HEALTHYNY (1-866-432-5849)
or at their website:
http://www.ins.state.ny.us/healthny.htm
More Questions?
If you have any questions, please call 1-877-9-FHPLUS (1-877-934-7587).
Medical Transportation
Medicaid can pay for transportation to and from emergency medical care and services. Medicaid can also pay for transportation to and from Medicaid billable non-emergency medical care or services for a Medicaid eligible individual or reimburse that individual for the expense related to public transportation or private vehicle use.
In non-emergency situations, prior approval of the Department is required to ensure that:
- the mode of transportation, (i.e. private vehicle, public transit, taxi, ambulette, ambulance) is appropriate to the medical needs of the client.
- the least costly appropriate transportation is arranged.
If your medical condition requires you to travel by taxi, ambulette or ambulance, effective January 1, 2012 you must contact Logisticare Solutions, the Department's transportation coordinator, at 1-877-813-5602. If you are hearing impaired (TTY) please call 1-866-288-3133. If you are traveling by private vehicle or public transit, you must contact the Department's Medical Services Unit at 516-227-8070 for prior approval of reimbursement.
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Home Care
Medicaid can pay for approved licensed personal care
and home health care services for people financially
eligible for Medicaid. To have this service approved
requires a nursing assessment.
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Skilled Nursing Facility
Medicaid can pay for eligible individuals in a licensed
skilled nursing facility.
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Transitional Medical Assistance
Transitional Medical Assistance (MA)
provides continued medical assistance coverage to people
who become ineligible for Family
Assistance or medical
assistance with budgeting and who have a dependent child
under the age of 21 living with them. Transitional
MA benefits are available for six months to those who
lose family assistance due to:
- new employment
- increased earned income
- loss of earned income disregards
An additional six months of medical assistance may be possible if the person remains employed; has earned income below certain levels; and has a dependent child under the age of 21 living with them.
Department of Social Services General Information: (516) 227-8519
Related Links:
New York State
Department of Health
New York State DOH Consumer Page
New York State DOH Child Health Plus
