You may qualify for Medicaid depending on your age, financial circumstances, family situation, or living arrangement.

Use the link below to see which health insurance options are available to you, including if your income qualifies you for NYS Medicaid.

• New York State of Health, the Official Health Plan Marketplace

When you complete the Access NY Health Care application (DOH-4220) or apply through NY State of Health you may assign a representative. You may allow this representative to apply for and/or renew Medicaid for you, discuss your Medicaid application or case, and/or allow them to get notices and correspondence. You can authorize or change a representative at renewal or anytime in between renewals.

If you recieve Medicaid through your local department of social service (LDSS), you may fill out form DOH-5247 and submit this with your renewal.

If you recieve Medicaid through NY State of Health, you may fill out form DOH-5085 and submit to NY State of Health.

• 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-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-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 office/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 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 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.
• **Note: As a condition of eligibility for Medicaid, if you appear eligible for Medicare, you must apply and show proof of application.
  You are required to apply for Medicare if:
  • You have Chronic Renal Failure or Amyotrophic Lateral Sclerosis (ALS); OR
  • You are turning age 65 in the next three months or are already age 65 or older; AND your income is below 120% of the Federal Poverty Level (based on the household size for a single individual or married couple), or is at or below the applicable Medicaid Standard, then the Medicaid program will pay or reimburse you the cost of your Medicare premiums. If the Medicaid program can pay your premiums, you will be required to apply for Medicare as a condition of Medicaid eligibility.

  Proof of Medicare application can be:

  • Your award or denial letter from the Social Security Administration, OR
  • Your on-line confirmation letter stating that you have applied for Medicare with the Social Security Administration.

  Apply Now:

  • https://www.ssa.gov/medicare/
  • https://www.medicare.gov/people-like-me/new-to-medicare/getting-started-with-medicare.html
  • Social Security Administration 1-800-772-1213

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 for some consumers, can also pay your Medicare deductibles, coinsurance, and copayments.

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.

Effective January 1, 2022

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.

For more information on Trusts, please visit our Trust-Specific information page.

Yes, some people can. If you are under 21 years of age, over 65 years of age, certified blind, certified disabled, pregnant, or a parent of a child under 21 years of age, you may be eligible for Medicaid if your income is above these levels and have medical bills. For more information please visit the Medicaid Excess Income Program webpage.

People who are certified blind, certified disabled, or age 65 or older who have more resources may also be eligible.

If an adult has too much income and/or resources and is not eligible for Medicaid, they may be eligible for the Family Planning Benefit Program.

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.

• * 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.

• Medicaid Excess Income Program

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.

Additional information on the Family Planning Benefit Program, including how to apply, can be found here.

Additional information on Child Health Plus, including how to apply, can be found here.

Personal privacy rights apply to all Medicaid applications and participants. The New York State Personal Privacy Protection Law and the federal Privacy Act require the New York State Department of Health to tell you what it does with the information, including Social Security Numbers (SSN) that you give the State or sometimes, to your LDSS, about you and your family. The Privacy Act statement is on your application form.

If you think any decision about your eligibility determination is wrong, or you do not understand any decision, talk to your application counselor or contact NY State of Health customer service center or your LDSS or HRA, depending on where you applied for Medicaid. If you still disagree or do not understand, you have the right to a Conference and an appeal through a hearing.

If you live anywhere in New York State, you may request a fair hearing or appeal by telephone, fax, online, or by writing. How you make the request depends on who made your eligibility decision; a Local Department of Social Service (LDSS) or HRA, or the NY State of Health.

1. Telephone: (800) 342-3334 Please have the notice, if any, available when you call.
2. Fax: (518) 473-6735
3. Online: Complete and submit the Online Request Form
4. In Writing: On the notice, complete the space proveded and send a copy of the notice, or write to:
   NYS Office of Temporary and Disability Assistance
   Office of Administrative Hearings
   P.O. Box 1930
   Albany, New York 12201-1930

1. Telephone: (855) 355-5777
2. Fax: (855) 900-5557
3. Online: www.nystateofhealth.ny.gov
4. In Writing: New York State of Health
   P.O. Box 11729
   Albany, New York 12211

Please keep a copy of any notice for yourself.

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.

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)

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:

• Spouse
• 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.