Medicaid in New York State
- 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 have an immediate need for Personal Care Services or Consumer Directed Personal Assistance Services, can I get my eligibility for these services processed more quickly?
- 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?
- Medicaid for the Treatment of an Emergency Medical Condition Fact Sheet
- I just want Family Planning Benefits. How do I apply?
- I want to know more about Child Health Plus.
- Why did I receive a 1095-B tax form from New York State Department of Health, what does it mean, and what do I do with it?
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 find my local Medicaid office?
- 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?
- How do I obtain Medicaid payment records, whether by request or by subpoena?
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?
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 financial requirements.
You may apply for Medicaid in the following ways:
- NY State of Health, The Official Health Plan Marketplace (855)355-5777
- Online website
- Managed Care Organization (MCO)
- Navigators and Certified Application Counselors
- Medicaid Helpline (800)541-2831
- Local District Social Services Offices
Where you apply for Medicaid will depend on your category. Your category might be single, childless couples, pregnant women, parent(s) and caretaker relatives with dependent children, elderly and/or disabled.
The Marketplace, (NY State of Health) determines eligibility using Modified Adjusted Gross Income (MAGI) Rules. In general, income is counted with the same rules as the Internal Revenue Service (IRS) with minor variations. Applications may be completed online, in person with a navigator or certified application counselor, by mail and by phone.
The following individuals should apply in the Marketplace, (NY State of Health):
- Adults (not pregnant) and aged 19-64, not eligible for Medicare;
- Pregnant Women and Infants;
- Children ages 1 - 18; and
- Parents and Caretaker Relatives
The following individuals should apply with their Local Department of Social Services (LDSS):
- Individuals age 65 and older, who are not parents or caretaker relatives, when age is a condition of eligibility;
- Individuals whose eligibility is based on being blind or disabled or who request coverage for community based long term care (CBLTC) services; including those individuals with an immediate need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS);
- Medicare Savings Program (MSP);
- Medicaid Buy-In for Working People with Disabilities enrollees (MBI-WPD);
- Former Foster Care youth;
- Residents of adult homes and nursing homes;
- Residential treatment center/community residences operated by The Office of Mental Health (OMH); and
- Presumptive Eligibility (PE) for Pregnant Women apply with provider, processed by the LDSS.
The necessary documentation needed to apply for Medicaid will depend on your category, whether you fall under the Modified Adjusted Gross Income (MAGI) guidelines or non-MAGI guidelines which are defined in the following section.
MAGI Eligibility Groups include:
- Pregnant Women
- Infants and Children under age 19
- Childless Adults who are: not pregnant, age 19-64, not on Medicare, and could be certified disabled but not on Medicare
- Parents/Caretaker Relatives
- Family Planning Benefit Program
- Children in Foster Care (Chafee)
Non – MAGI Eligibility Groups include:
- Individuals who are age 65 or older, who are not a parent or caretaker relative, individuals who are blind or disabled who do not meet the criteria of any of the MAGI eligibility groups
- Medicare Savings Program (MSP)
- AIDS Health Insurance Program (AHIP)
- Medicaid Buy-In for Working People with Disabilities
- Medicaid Cancer Treatment Program
- Residents of Adult Home run by LDSS, OMH Residential Care Centers/Community Residences
Application for Non-MAGI
The following paper application may only be printed and completed if you are applying at a local department of social services (LDSS) for Medicaid because you are over the age of 65 or an individual in your household is deemed certified blind or disabled or you are applying for Medicaid with a spenddown.
If you are blind or visually impaired many of DOH's forms are available in alternative format
DOH-5130 - Alternative Format Supplement - Options to receive information if you are blind or visually impaired.
There are two Supplements: DOH-4495A and DOH-5178A. Please read the instructions below to see which Supplement you should use.
If you reside in one of the counties listed below, use Supplement DOH-5178A.
- Albany County
- Cayuga County
- Chemung County
- Herkimer County
- Jefferson County
- Lewis County
- Livingston County
- Madison County
- Monroe County
- Montgomery County
- Oneida County
- Onondaga County
- Ontario County
- Oswego County
- Rensselaer County
- Saratoga County
- Schenectady County
- Schoharie County
- Schuyler County
- Seneca County
- Steuben County
- Suffolk County
- Warren County
- Washington County
- Wayne County
- Yates County
If you DO NOT reside in one of the counties listed above, use Supplement DOH-4495A.
Note: A new system called the Asset Verification System has started in the counties listed above. The Asset Verification System will verify certain resources through computer matches. Because the initial pilot stage of the Asset Verification System is limited to the counties listed above, only residents of those counties should use Supplement DOH-5178A.
If I have an immediate need for Personal Care Services or Consumer Directed Personal Assistance Services, can I get my eligibility for these services processed more quickly?
- Immediate Need for Personal Care Services/Consumer Directed Personal Assistance Services: Informational Notice and Attestation Form (OHIP-0103).
If you think you have an immediate need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS), you may have your eligibility for these services processed more quickly if you:
- have no voluntary informal caregivers able and willing to provide or continue to provide care;
- are not receiving needed assistance from a home care services agency;
- have no third party insurance or Medicare benefits available to pay for needed assistance; and
- have no adaptive or specialized equipment or supplies in use to meet, or that cannot meet, your need for assistance.
If you don´t have Medicaid coverage, you may ask to have your Medicaid application processed more quickly by sending in: a completed Access NY Health Insurance Application (DOH-4220); an **Access NY Supplement A (DOH-4495A)/(DOH-5178A), if needed; a physician´s order for services; and a signed "Attestation of Immediate Need" (OHIP-0103) to your local department of social services.
If you already have Medicaid coverage that does not include coverage for community-based long term care services, you must send in an **Access NY Supplement A (DOH-4495A)/(DOH-5178A), if needed, a physician´s order for services and a signed "Attestation of Immediate Need" (OHIP-0103) to your local department of social services.
If you already have Medicaid coverage that includes coverage for community-based long term care services, you must send in a physician´s order for services and a signed "Attestation of Immediate Need" (OHIP-0103) to your local department of social services.
If you don´t already have Medicaid coverage or you have Medicaid coverage that does not include coverage for community-based long term care services: All of the required forms (see the appropriate list, above) must be sent in to your local social services office or, if you live in NYC, to the Human Resources Administration (HRA). As soon as possible after receiving all of these forms, the social services office/HRA will then check to make sure that you have sent in all the information necessary to determine your Medicaid eligibility. If more information is needed, they must send you a letter, by no later than four days after receiving these required forms, to request the missing information. This letter will tell you what documents or information you need to send in and the date by which you must send it. By no later than 7 days after the social service office/HRA receives the necessary information, they must let you know if you are eligible for Medicaid. By no later than 12 days after receiving all the necessary information, the social services office/HRA will also determine whether you could get PCS or CDPAS if you are found eligible for Medicaid. You cannot get this home care from Medicaid unless you are found eligible for Medicaid. If you are found eligible for Medicaid and PCS or CDPAS, the social services office/HRA will let you know and you will get the home care as quickly as possible.
If you already have Medicaid coverage that includes coverage for community-based long term care services: The physician´s order and the signed Attestation of Immediate Need must be sent to your local social services office or HRA. By no later than 12 days after receiving these required forms, the social services office/HRA will determine whether you can get PCS or CDPAS. If you are found eligible for PCS or CDPAS, the social services officeial/HRA will let you know and you will get the home care as quickly as possible.
**Note: Individuals with an immediate need for Personal Care Services or Consumer Directed Personal Assistance Services may attest to the current value of any real property and to the current dollar amount of any bank accounts.
If you qualify under a MAGI eligibility group, you will have to provide documents to verify eligibility if necessary.
- If you are applying for Medicaid through the Marketplace (NY State of Health), you may attest to your household income for the upcoming year. If your income is different than the income found on the data matches, income documentation may need to be provided.
- Citizenship/Immigration status and social security number will be verified through federal data sources. If citizenship/immigration status or social security number does not match, documentation must be provided.
If you qualify under a non-MAGI eligibility group, the following is a guide to the documentation that must be submitted to help determine eligibility:
- 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 the Social Security Administration (SSA) will verify your SSN, date of birth 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 to submit proof of naturalization (e.g., Naturalization Certificate (N-550 or N-570) or a U.S. passport.
- Proof of citizenship or immigration status*
- Proof of age (if not verified by SSA), like a birth certificate
- Four weeks of recent paycheck stubs (if you are working)
- Proof of your income from sources like Social Security, Veteran´s Benefits (VA), retirement benefits, Unemployment Insurance Benefits (UIB), Child Support payments
- If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information on bank accounts, insurance policies and other resources
- Proof of where you live, such as 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 and you meet all other Medicaid eligibility requirements.
If I think I am eligible for Medicaid, should I cancel any other health insurance I might already have?
No. If you currently pay for health insurance or Medicare coverage or have the option of getting that coverage, but cannot afford the payment, Medicaid can pay the premiums under certain circumstances.
Even if you are not eligible for Medicaid benefits, the premiums can still be paid, in some instances, if you lose your job or have your work hours reduced. If you need help with a COBRA premium, you must apply quickly, to determine if Medicaid can help pay the premium.
You may be eligible for the Medicare Savings Program. This program pays your Medicare premiums and deductibles.
If you have Acquired Immune Deficiency Syndrome (AIDS), Medicaid may be able to help pay your health insurance premiums.
The chart below shows how much income you can receive in a month and the amount of resources (if applicable) you can retain and still qualify for Medicaid. The income and resource (if applicable) levels depend on the number of your family members who live with you.
The Medicaid Income Level for Single People and Couples without Children will be updated for 2016 with the release of the 2016 Federal Poverty Levels.
|Family Size||Net Income for Individuals who are Blind, Disabled or Age 65+||Medicaid Income Level for Single People, Couples without Children||Resource Level (Individuals who are Blind, Disabled or Age 65+ ONLY)|
|For each additional person, add:||$2,175||$182||$5,741||$479||$3,263|
*Effective January 1, 2016
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 (if applicable) of legally responsible relatives in the household will also be counted.
Yes, some people can. Pregnant women, children, disabled persons, and others may be eligible for Medicaid if their income is above these levels and they have medical bills. Ask your Medicaid worker if you fit into one of these groups.
Click here for more information on the Medicaid Excess Income program.
Individuals who are certified blind, certified disabled, or age 65 or older who have more resources may also be eligible. Ask your Medicaid worker if this applies to you.
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 - 223% of the federal poverty level.
- Children age 1 through 18 years - 154% of the federal poverty level.
|Number in Family||154% FPL**||223% FPL**|
|For each additional person, add:||$534||$774|
* 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.
We may be able to pay you for some bills you paid before you asked for Medicaid. You can be paid for bills you paid before you asked for Medicaid and for bills you pay until you get your Medicaid card. Bills you paid before you asked for Medicaid must be for services you received on or after the first day of the third month before the month that you asked for Medicaid. For example, if you ask for Medicaid on March 11th, we may be able to pay you for services you received and paid for from December 1st until you get your Medicaid card.
We can pay you for some bills even if the doctor or other provider you paid does not take Medicaid, even if you paid the bills before you asked for Medicaid. After the day you ask for Medicaid, we can pay you only if the doctor or other provider takes Medicaid.
Always ask the doctor or other provider if he or she takes Medicaid. After you ask for Medicaid, we will not pay you if the doctor or other provider does not take Medicaid.
There are a few more rules:
- The bills you paid must be for services that the Medicaid program pays for. These services include, but are not limited to, doctors, home care, hospitals and drugs.
- We may only be able to pay what Medicaid pays for the services. This may be less than the bill you paid.
- We can pay you only when we decide you can get Medicaid and only if you could have gotten Medicaid when you paid the bill.
- We can pay you only when the bills you paid were for services that you needed.
- You must give us the bills and prove that you paid them.
Generally, a determination of eligibility must be done and a letter sent notifying you if your application has been accepted or denied within 45 days of the date of your application. If you are pregnant or applying on behalf of children, a determination should be made within 30 days from the date of your application. If you are applying and have a disability which must be evaluated, it can take up to 90 days to determine if you are eligible.
What are my rights?
The Medicaid application, Access NY Health Care, tells you what your rights are when you apply for Medicaid. See the pages titled "Terms, Rights and Responsibilities." People who receive Medicaid have privacy rights. Medicaid keeps your health information private and shares it only when we need to.
If you are not satisfied with a decision made by the local social services district, you may request a conference with the agency. You may also appeal to the New York State Office of Temporary and Disability Assistance and request a Fair Hearing.
If your eligibility decision was made at the Local Department of Social Services:
1) Telephone: You may call the state wide toll free number: 800-342-3334; OR
2) Fax Number: (518) 473-6735; OR
3) On-Line: Complete and send the online request form at: http://otda.ny.gov/programs/applications/; OR
4) Write: to the Fair Hearing Section, New York State Office of Temporary and Disability Assistance, P.O. Box 1930, Albany, New York 12201.
In New York City you can also:
Bring a copy of this notice to the New York State Office of Temporary and Disability Assistance at:
- 14 Boerum Place, 1st Floor, Brooklyn, or
- 111 Livingston Street, 4th Floor, Brooklyn, NY 11201
If your eligibility decision was made by the Marketplace, (NY State of Health):
New York State of Health
P.O. Box 11729
Albany, New York 12211
Please keep a copy of any notice for yourself
If your request involves any issues about health benefits or services provided under your Managed Care Plan or Managed Long Term Care you can write to:
NYS Office of Temporary and Disability Assistance
Office of Administrative Hearings
Managed Care Hearing Unit
P.O. Box 22023
Albany, New York 12201-2023
Fax: your copy of the notice, or your written request to 518 473-6735
Time limits to ask for a fair hearing or appeal – If you want to ask for a fair hearing or appeal, call right away because there are time limits. If you wait too long, you may not be able to get a fair hearing or appeal.
If you receive medical services paid for by Medicaid on or after your 55th birthday, or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.
For individuals who received Medicaid under a MAGI eligibility group, the estate recovery is limited to the amount Medicaid paid for the cost of nursing facility services, home and community-based services, and related hospital and prescription drug services received on or after the individual’s 55th birthday.
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, except for pharmacy services, where a small co-pay will be applied.
- 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).
The following services are subject to a co-payment:
- Clinic Visits (Hospital-Based and Free Standing Article 28 Health Department-certified facilities) - $3.00;
- Laboratory Tests performed by an independent clinical laboratory or any hospital-based/free standing clinic laboratory - $0.50 per procedure;
- Medical Supplies including syringes, bandages, gloves, sterile irrigation solutions, incontinence pads, ostomy bags, heating pads, hearing aid batteries, nutritional supplements, etc. - $1.00 per claim;
- Inpatient Hospital Stays (involving at least one overnight stay; is due upon discharge) - $25.00;
- Emergency Room - for non-urgent or non-emergency services - $3.00 per visit;
- Pharmacy Prescription Drugs - $3.00 Brand Name Non-Preferred, $1.00 Brand Name Preferred, $1.00 Brand When Less Than Generic, $1.00 Generic;
- Non-Prescription (over the counter) Drugs - $0.50.
There is no co-payment on private practicing physician services (including laboratory and/or x-ray services, home health services, personal care services or long term home health care services).
You are responsible to pay a maximum of up to $200 in a co-pay year. Your year begins on April 1st and ends March 31st each year. If you reach your maximum of $200, a letter will be sent to you exempting you from paying Medicaid co-payments until April 1st.
The following are exempt from all Medicaid co-payments:
- Children under 21.
- Pregnant women. (Pregnant women are exempt during pregnancy and for the two months after the month in which the pregnancy ends.)
- Family planning (birth control) services -This includes family planning drugs or supplies like birth control pills and condoms.
- Residents of an Adult Care Facility licensed by the New York State Department of Health.
- Residents of a Nursing Home.
- Residents of an Office of Mental Health (OMH) or Office for People with Developmental Disabilities (OPWDD) certified Community Residence.
- Enrollees in a Comprehensive Medical Case Management (CMCM) or Services Coordination Program.
- Enrollees in the Home and Community Based Services (HCBS) or Traumatic Brain Injury (TBI) waiver programs.
- Psychotropic and Tuberculosis drugs.
- Members with incomes below 100 percent of the federal poverty level.
- Members in Hospice.
- American Indians and Alaska Natives who have ever received a service from the Indian Health Service, tribal health programs or under contract health services referral.
You cannot be denied care or services because of your inability to pay a co-payment. A provider has the right to ask you for the co-payment at each visit and bill you for any unpaid co-payments.
A Medicaid Managed Care health plan will provide your care by working with a group (network) of doctors, clinics, hospitals and pharmacies. You will choose one of the doctors from the health plan to be your Primary Care Provider (PCP). Your PCP will provide most of your care. You will need a referral from your PCP to see a specialist and for other services.
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.
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.
Why did I receive a 1095-B tax form from New York State Department of Health, what does it mean, and what do I do with it?
The Affordable Care Act (ACA) requires most Americans to have health coverage that meets Minimum Essential Coverage (MEC). Health coverage providers are required to report certain health benefit information to the Internal Revenue Service (IRS). The tax form you received, Form 1095-B, represents health coverage you received in Medicaid, Child Health Plus (CHP) or Essential Plan (EP) for part or all of the past year. New York State Department of Health reports the months you had MEC directly to the IRS on your behalf and sends you a copy of the 1095-B for your records. This form does not require any action on your part. You may receive additional 1095-B forms from more than one provider if you changed coverage in the past year.
For additional information about the 1095-B form you received, please click on the following link.
If you receive a letter from the IRS, please click on this link for additional information.
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 even if your income is otherwise too high.
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.
Resources are cash or those assets, which can be readily converted to cash, such as bank accounts, life insurance policies, stocks, bonds, mutual fund shares and promissory notes. Resources also include property not readily converted to cash (i.e., real property)
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?
Yes. Under Medicaid you are allowed to keep a small amount for your personal needs. You can also keep some of your income for your family if they are dependent on you. A spouse who remains in the community may also keep resources and income above the levels shown.
When applying for Medicaid for nursing facility services (Nursing Home), the local department of social services will look at financial transactions to determine whether any assets have been transferred or given away for less than fair market value during a certain time period prior to your application in order to determine if a transfer of assets penalty period needs to be applied. This is known as the "lookback" period. Currently the "lookback" period is 60 months (5 yrs) prior to the month you are applying for coverage of nursing home care.
A penalty period may be imposed for the transfer of non-exempt assets for less than fair market value. The penalty period results in a period of ineligibility for Medicaid coverage of nursing facility services.
A penalty period is not applied for the transfer of your home to the following individuals:
- Child under the age of 21
- Sibling who has an equity interest in the home and has resided in the home for at least one year immediately prior to you entering the Nursing Home.
- Adult child who resided in the home for at least two years, immediately prior to you entering the Nursing Home and who provided care to you which permitted you to reside at home rather than in a medical facility.
For more information regarding the transfer of assets and penalty periods, please contact your local department of social services.
A life estate is limited interest in real property. A life estate holder does not have full title to the property, but has the use of the property for his or her lifetime, or for a specified period. The life estate is not considered a countable resource, and no lien may be placed on it.
If you or your spouse sell the life estate interest for less than fair market value, it can be considered a transfer of assets and may be subject to the penalty period.
You may establish an irrevocable pre-need funeral agreement with a funeral firm, funeral director, undertaker or any other person, firm or corporation which can create such an agreement for your funeral and burial expenses. Pre-need burial agreements purchased for certain members of your family on or after January 1, 2011 must also be irrevocable. The pre-need funeral agreement is used towards burial and funeral expenses and is not counted as a resource when determining Medicaid eligibility.
If you (your spouse) do not have an irrevocable pre-need funeral agreement or if the irrevocable pre-need agreement has less than $1500 designated for non-burial space items, you may be allowed to have money set aside in a burial fund. The limit for single individuals is $1500 or $3000 for a couple. Please note, these funds, must be kept separate from any non- burial fund related resources.
A community spouse is someone whose husband/wife is currently institutionalized or living in a nursing home. The community spouse is not currently living in a nursing home and usually resides at the couple´s home.
If your spouse is institutionalized or living in a nursing home, you will be permitted to keep some income known as a minimum monthly maintenance needs allowance (MMMNA). If you are currently receiving income in excess of the minimum monthly maintenance needs allowance, you may be asked to contribute twenty-five percent (25%) of the excess income to the cost of care for the institution
For current Medicaid Beneficiaries:
The Medicaid office is located in your local department of social services. A listing of offices can be located here: http://www.health.ny.gov/health_care/medicaid/ldss.htm
If you live in the five boroughs of New York City, your offices are run by the Human Resources Administration (HRA). A listing of offices can be found here: http://www1.nyc.gov/site/hra/locations/medicaid-locations.page
If your Medicaid is with your LDSS, to order a new Medicaid Benefit Identification Card, please call or visit your local department of social services.
If your Medicaid is with the Marketplace (NY State of Health) and you need to order a new benefit card please call the call center at 1-855-355-3777.
Members residing in the five boroughs of NYC can call the HRA Infoline at 1 (718) 557-1399 or the HRA Medicaid Helpline at 1(888) 692-6116.
Most renewals are on an annual basis. You will receive a renewal packet by mail prior to your renewal date. Your packet will let you know if there are other methods available to you for recertification such as phone or internet renewal.
Please note that Medicaid mail cannot be forwarded. This means that if you changed your address at the post office and not with the Medicaid office, you will not receive your Medicaid mail. You must notify your Medicaid office of all address changes to ensure you receive any notices sent by them.
If your Medicaid is with your Local Department of Social Services, it is important to notify your Medicaid office any time you move, especially when you are moving to another county. Your original county needs to notify the new county and get your case transferred.
If you are currently enrolled in a managed care plan that is not offered in the new county, your local department of social services will notify you so that you can choose a new plan.
If your Medicaid is with the Marketplace, (NY State of Health), it is important that you update your account with your new address.
To request a card for your unborn baby, you will need to contact your local department of social services or if your case is with the Marketplace, (NY State or Health), at 1 (855) 355-5777 and notify them that you are pregnant and what your anticipated due date is.
Those living in the five boroughs of NYC, whose cases are administered by the Human Resources Administration (HRA) office can call the HRA Infoline at 1 (718) 557-1399 or the HRA Medicaid Helpline at 1(888) 692-6116.
Once the Medicaid office receives the letter, they will issue you an unborn/infant card which you will use to take the baby to the doctor once he/she is born, until the child´s permanent card is issued.
You can report Medicaid fraud by calling the Fraud Hotline 1-877-873-7283 or by filing a complaint online.
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.