You may be covered by Medicaid if:

• You have high medical bills.
• You receive Supplemental Security Income (SSI).
• You meet certain financial requirements.

When you complete the Access NY Health Care application DOH-4220 you may assign a representative. You may allow them to apply for and/or renew Medicaid for you, discuss your Medicaid application or case and/or allow them to get notices and correspondence. If you would like to authorize or change a representative at renewal or anytime in between renewals, you may fill out DOH-5247 and submit this with your renewal. You can find this document here

• DOH-5247

• 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.

I just want Family Planning Benefits. How do I apply?

• How to apply

I want to know more about Child Health Plus.

• Child Health Plus

What is a Trust?

A trust is a legal instrument by which an individual gives control over his/her assets to another (the trustee) to disburse according to the instructions of the individual creating the trust. A trust can contain:

• Cash or other liquid assets; and
• Real or personal property that could be turned into cash.

What Things Count as Assets and are Used to Establish a Trust?

Assets often placed in trust include income, accumulated resources, and real property.

How Does a Trust Affect My Medicaid Benefits?

As a general rule, if you use your assets to establish a trust on or after January 1, 2000, all or part of the trust assets will be counted as your resource for purposes of determining your Medicaid eligibility.

• In the case of a revocable trust, the whole trust is your resource.
• In the case of an irrevocable trust, if there are any circumstances under which payment could be made to you or for your benefit, the portion of the trust from which payment could be made is your resource.

Are There Any Exceptions to These Counting Rules?

There are certain exceptions that apply to:

• "Special needs trusts" (sometimes referred to as "supplemental needs trusts") which are created for the benefit of a certified disabled person under the age of 65. A "special needs trust" must:
  • be created with the individual´s own assets;
  • be created by the disabled person, by the disabled person´s parent, grandparent, or legal guardian, or by a court; and
  • include language specifying that upon the death of the disabled person, the state will receive all amounts remaining in the trust, up to the amount of Medicaid paid out on behalf of the individual; and
• "Pooled trusts" which are created for the benefit of a certified disabled person of any age. To be considered a "pooled trust":
  • the trust must be established and managed by a non-profit association;
  • the trust maintains separate accounts for each person whose assets are included in the pooled trust, but pools these accounts for purposes of investment and management of the trust funds;
  • the disabled individual´s account in the trust must be established by the disabled individual, by the disabled individual´s parent, grandparent or legal guardian, or by a court; and
  • the trust must include language specifying that upon the death of the individual, funds not retained by the non-profit organization will go to the state, up to the amount of Medicaid paid out on behalf of the individual.

Medicaid will not count the assets in a special needs trust or pooled trust if it meets the described criteria. Income directly diverted to one of these types of trusts or received and then placed into the trust is not counted as income. Verification that the income was placed into the trust is required. Any trust assets distributed to the disabled individual are counted as income.

How Do I Request that the Local Social Services District Rebudget My Income
              Once I have Created a Trust?

You must provide a copy of the trust to your local social services district. You must include a written statement indicating the amount of monthly income that will be placed into the trust each month.

How Does Money from a Trust that is Not My Resource Affect My Medicaid Benefits?

• Money paid directly to you from the trust is counted as income.
• Money paid directly to someone for your benefit will not count as income (e.g., food, shelter, telephone bills, education, entertainment, etc.).

How Can I Find Out More About Setting Up a Trust?

If you are interested in setting up a trust, you should consult a lawyer or financial advisor. You may be able to get a lawyer at no cost to you by calling your local Legal Aid or Legal Services Office. For the names of other lawyers, call your local or State Bar Association.

Note: Also, for married and single individuals, assets that you may use to fund a trust and which we may not count while you are living in the community, will count in determining the amount of income you must contribute toward the cost of long term nursing home care. Additional rules apply to transfers to and from trusts under the transfer of assets provisions.

If you are married and your Medicaid eligibility is determined under spousal impoverishment budgeting with post-eligibility rules (e.g. you are enrolled in a Medicaid Managed Long Term Care plan.), any of your income placed in a trust will count in determining your eligibility.

This Information is General.
For Questions Call 1-800-541-2831.

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:

• 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.

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 here; 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):

Online: www.nystateofhealth.ny.gov

Telephone: 1-855-355-5777

Fax: 1-855-900-5557

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:

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.

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.