New York Medicaid: The Medicaid Project, New York Medicaid Eligibility, Programs, Requirements

Topics on this page:

New York Medicaid definition, About Medicaid
Medicaid in New York: How It Works
New York Medicaid Eligibility, Requirements
New York Medicaid Citizenship Requirements
Applying for New York Medicaid
New York Medicaid Offices; Medicaid HOTLINE
New York Medicaid Health Plans, Managed Care, HMO
Health Programs for Children: CHIP: New York
New York Medicaid Benefits and Coverage: Medicaid Services

New York Health Insurance: Affordable Health Insurance, Health Care Options (on a separate page)
Medicaid Dental Services
New York Medicaid Prescription Drugs; Preferred Drug List
New York Medicaid and Nursing Homes, Assisted Living
New York Medicaid Waiver Programs
Report Medicaid Fraud in New York; HOTLINE

About Medicaid in New York*: "Medicaid is a program for New Yorkers who can't afford to pay for medical care. Medicaid pays for a number of services, 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. "
*source: GovBenefits.gov (www.GovBenefits.gov) , Washington, D.C.

New York State Children’s Medicaid and Children's Health Insurance Program:: "New York State has a health insurance plan for kids, called Child Health Plus. Depending on your family's income, your child may be eligible to join either Children's Medicaid or Child Health Plus . Both Children's Medicaid and Child Health Plus are available through dozens of providers throughout the state."
*source: New York State Health Department (DOH), Albany, NY 12237

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Medicaid in New York: How It Works; An Introduction to New York Medicaid; What is New York Medicaid?

web page:
Medical Assistance Program

source:City of New York, Human Resources Administration
languages: English
"Most low-income families and individuals who cannot afford to pay for their medical care including pregnant women, children, persons receiving cash assistance or Social Security Income (SSI), persons who are 65 and over, the disabled and the blind, are eligible for Medicaid..."
- also from City of New York Human Resources Administration:
  web page:
  Public Health Insurance
  languages: English
  from the web page:
  "...Plans include: Medicaid; Child Health Plus; Family Health Plus; Medicare Savings Plan (also known as Medicare Buy-In); Medicaid Buy-In Program for Working People with Disabilities; and the Family Planning Benefit Program..."
- web page:
  Medicaid Excess Income Program
  languages: English
  from the web page:
  "...The Medicaid Excess Income Program also known as the "Medicaid Spenddown Program" or the "Medicaid Surplus Income Program" offers Medicaid coverage to individuals whose net monthly income is above the Medicaid income limits and who meet all other Medicaid eligibility requirements..."

web page:
Medicaid in New York State (FAQ's)

source:New York State Department of Health
languages: English
(Extensive explanation of how the New York Medicaid program works; with eligibility and requirements data.) "...How do I know if I qualify for Medicaid?; How do I apply for Medicaid?; If I think I am eligible for Medicaid, should I cancel any other health insurance I might already have?..."
brochure:
MEDICAID IN NEW YORK STATE - Separating Fact from Fiction

source:Healthcare Association of New York State (HANYS)
file size: 20 pg. languages: English
from the brochure:
"...New York State’s Medicaid program has established an unparalleled record of caring for the most vulnerable people in our communities. Medicaid and the associated Child Health Plus and Family Health Plus programs provide health care coverage for children and adults, expectant mothers, disabled individuals, the elderly, and people struggling with mental illness..."
web page:
MEDICAID | New York

source:healthinsuranceinfo.net - Georgetown University's Health Policy Institute
languages: English
from the webpage:
"...Medicaid is a program that provides health coverage to some low-income New York residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines ...."
web page:
Key Medicaid Information for New York for 2010

source:Elder Law Answers
languages: English
Explains important basics about New York Medicaid. Topics include protections for the community spouse, transfers, income, and estate recovery...
web page:
New York Medicaid

source:GovBenefits.gov - Your Benefits Connection
languages: English
from the web page:
" Medicaid is a program for New Yorkers who can't afford to pay for medical care. Medicaid pays for a number of services, 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 ..."
web page:
New York & United States State Medicaid Fact Sheets

source:Kaiser Family Foundation
languages: English
brochure or publication:
Medicaid At-a-Glance 2005

source: Centers for Medicare & Medicaid Services
file size: 12 pg. languages: English
A brief explanation of the Medicaide program.

New York Medicaid Eligibility, Requirements

web page:
How do I know if my income and resources qualify me for Medicaid?

source:New York State Department of Health
languages: English
from the web page:
"...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..."
brochure or publication:
YOUR GUIDE TO PUBLIC HEALTH INSURANCE & ELIGIBILITY - You Can Qualify

source:City of New York, Human Resources Administration
2 pages; languages: English
from the web page:
"...You can qualify for Public Health Insurance even if you have income, own a house, own a car, have a bank account or receive private health insurance..."
- also from The City of New York, Human Resources Administration:
  brochure:
  2010 NYS INCOME AND RESOURCE STANDARDS AND FEDERAL POVERTY LEVELS (Effective 01/01/10)
  2 pages; languages: English
  from the brochure:
  "...PCAP and Medicaid Monthly Income Levels (Pregnant Women and Children Under 19)..."
- web page:
  Public Health Insurance Prescreening System
  languages: English
  from the web page:
  "...The pre-screening system is for individuals and families living in New York City. This system can help you find out if you and your family qualify financially for Medicaid, Family Health Plus, or Child Health Plus..."
web page:
Review of Medicaid Eligibility in New York State (2006)

source:HHS-OIG-Organization-Office of Audit Services
languages: English
from the web page:
"...objective was to determine the extent to which the State agency made Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements. The State agency (1) made some Medicaid payments on behalf of beneficiaries who did not meet Federal and State eligibility requirements and (2) did not always adequately document eligibility determinations..."
web page:
Louisiana Medicaid Program

source:GovBenefits.gov - Your Benefits Connection
languages: English
from the web page:
" The Louisiana Medicaid Program is a Federally funded program, which provides health coverage to Louisiana residents, within certain groups, based on income and resource limits set by Congress. Medicaid provides a complete package of medical coverage for those who qualify. Generally, eligible recipients of benefits include low income families with children, low-income elderly, and persons with disabilities. Persons who are entitled to Medicare Part A and/or Part B are also eligible..."
web page:
2011 HHS Poverty Guidelines

source: Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services
languages: English
from the web page:
"...The poverty thresholds are the original version of the federal poverty measure... The poverty guidelines are the other version of the federal poverty measure.
web page:
Medicaid Eligibility

source: Centers for Medicare & Medicaid Services
languages: English
from the web page:
Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
brochure:
BASIC ELIGIBILITY FOR MEDICAID HOME CARE

source:New York Health Access
10 pages; languages: English
from the brochure:
"...This is basic general information about applying for Medicaid and home care, known as "home attendant" or "personal care." To receiveMedicaid home care, you must be both financially and medically eligible...."

New York Medicaid Citizenship Requirements

web page:
Residency Requirements for Medicaid Eligibility

source:Blustein, Shapiro, Rich & Barone, LLP.
languages: English
from the web page:
"...To receive Medicaid in New York, an applicant must be a resident of the state. There is no durational requirement for a person to establish residency in New York; a Medicaid applicant who satisfies the financial eligibility criteria can be a resident of New York for a single day to obtain Medicaid coverage. In general, a person will be deemed a resident of New York if they are living in the state ..."

Applying for New York Medicaid

brochure or publication:
Access New York Health Care Health Insurance Application for Children, Adults and Families

source:New York State's Family Health Plus (New York State Department of Health)
languages: English, Spanish
from the web page: "This one application can be used to apply for Child Health Plus, Family Health Plus, Medicaid, and the Family Planning Benefit Program. Based upon the information you provide you will be told which program you and/or your children are eligible for..."

Versión en Español: Applicación
- also from New York State's Family Health Plus:
  publication:
  What will happen when I apply?
  pg. languages: English
  from the web page: "Your local department of social services and Facilitated Enrollers are available to assist you in completing your application for public health insurance. They can help you fill out an application, choose a health plan and answer any questions you may have. You and your family members can apply for several public health insurance programs (Medicaid, Family Health Plus and Child Health Plus) using a single application..."
- publication:
  Documents Needed When You Apply for Health Insurance
  pg. languages: English
  
  Versión en Español: Documentos Necesarios Para Solicitar Seguro médico
brochure or publication:
How and Where to Apply for Public Health Insurance

source:City of New York, Human Resources Administration
4 pages; languages: English, Spanish
from the web page:
"...To find out if you are eligible for public health insurance such as Medicaid, Family Health Plus or the Medicare Savings Program, you have the option of applying by mail. You may also choose to visit any Medical Assistance Program Community Office or the office of any Facilitated Enroller for assistance..."

New York Medicaid Offices; Medicaid HOTLINE

web page:
Local Departments of Social Services

source:New York State Department of Health
languages: English
"...Albany County... Broome County... Cattaraugus County... Cayuga County... Chautauqua County..."
hotline:
New York Medicaid Hotline
According to the New York State Department of Health: "Medicaid Co-Payment Hotline 1-800-541-2831 ; Medicaid Newborn Helpline 1-877-463-7680 ..."
web page:
Bronx Medicaid Offices

source:City of New York, Human Resources Administration
languages: English
from the web page:
"...Bronx Lebanon Hosp. Medicaid Office... Lincoln Hospital Medicaid Office... North Central Bronx Hosp. Medicaid Office... Morrisania Medicaid Office..."
- also from The City of New York, Human Resources Administration:
  web page:
  Brooklyn Medicaid Offices
  languages: English
  from the web page:
  "...Boerum Hill Medicaid Office... Bushwick Medicaid Office... Coney Island Medicaid Office... Kings County Hosp. Medicaid Office..."
- web page:
  Manhattan Medicaid Offices
  languages: English
  from the web page:
  "...Bellevue Hospital Medicaid Office... Chinatown Medicaid Office... Metropolitan Hospital Medicaid Office... Manhattanville Medicaid Office... Health and Human Services Office at Columbia Presbyterian..."
- web page:
  Queens Medicaid Offices
  languages: English
  from the web page:
  "...Elmhurst Hospital Medicaid Office ... Jamaica Medicaid Office... Rockaway Medicaid Office..."
- web page:
  Staten Island Medicaid Office
  languages: English
  from the web page:
  "...Staten Island Medicaid Office ..."

New York Medicaid Health Plans, Managed Care, HMO

web page:
(New York) Medicaid and Managed Care

source:New York State Department of Health
languages: English
from the web page: "...Medicaid Managed Care offers many New Yorkers a chance to choose a Medicaid health plan. Managed Care plans focus on preventive health care and provide enrollees with a medical home for themselves and their families...."
- also from New York State Department of Health:
  web page:
  Medicaid Managed Care (MMC) by County
  languages: English
  
  from the web page: "...To learn more about Medicaid Managed Care, select a county from the map below...."
- web page:
  Medicaid Managed Care in New York City
  
  source:New York City Department of Health
  languages: English
  from the web page: "...In September 2010, the State Department of Health will begin to expand mandatory managed care enrollment in New York City to Medicaid ..."
- web page:
  Medicaid Managed Care
  
  source:NY Health Access
  languages: English
  from the web page: "...Most, but not all Medicaid beneficiaries in New York State must now join a Medicaid managed care plan. N.Y. Soc. Servs. L. §364-j. In regular Medicaid beneficiaries can go to any doctor who takes Medicaid. This is called fee-for-service..."

Children's Medicaid: Health Programs for Children: CHIP: New York

web page:
Child Health Plus

source:Health Plus
languages: English
from the web page:
"Since 1992, Health Plus has offered Child Health Plus - New York State's Health Plan for Kids. Child Health Plus/Health Plus provides a child or teenager with free or affordable health coverage depending on their household income. For most families, Child Health Plus/Health Plus may be FREE or have a small monthly cost..."
web page:
Family Health Plus and Child Health Plus

source:Healthy NY
languages: English
from the web page:
"...Family Health Plus is a public health insurance program run by the Department of Health for adults between the ages of 19 and 64 who do not have health insurance — either on their own or through their employers — but have incomes too high to qualify for Medicaid....New York State also has a health insurance plan for kids, called Child Health Plus. Child Health Plus is run by the Department of Health. Depending on your family’s income, your child may be eligible to join either Child Health Plus A (formerly Children’s Medicaid) or Child Health Plus B. ..."
web page:
(New York) Child Health Plus - What does it cost?

source:New York State Department of Health
languages: English
from the web page: "...There is no monthly premium for families whose income is less than 1.6 times the poverty level. That's about $563 a week for a three-person family, about $678 a week for a family of four. Families with somewhat higher incomes pay a monthly premium of ...."
- also from New York State Department of Health:
  web page:
  What benefits can you get for your kids?
  languages: English
  
  from the web page: "Well-child care; Physical exams; Immunizations; Diagnosis and treatment of illness and injury; X-ray and lab tests; Outpatient surgery; Emergency care...."
- web page:
  Where do your kids go for health care?
  languages: English
  
  from the web page: "If your child is enrolled in Children's Medicaid, you may be required to enroll in a managed care plan, or you may bring your child to any provider who accepts Children's Medicaid. If your child is enrolled in Child Health Plus..."
web page:
Health Insurance for Children: Medicaid (coverage for children) and Child Health Plus

source:City of New York, Human Resources Administration
languages: English, Spanish
from the web page:
"...Medicaid (coverage for children) is available for many children in working families. Most children who are eligible for Medicaid (coverage for children) will receive their medical care through a health plan, ..."
web page:
CCF - Medicaid and CHIP Programs New York

source:Georgetown University Center for Children and Families
languages: English
brochure or publication:
New York Medicaid Facts

source:American Academy of Pediatrics
2 pages; languages: English

from the brochure:
"The Medicaid program provides health insurance for over 1.7 million low-income children in New York. Medicaid is an indispensable health program providing health insurance coverage for part or all of the year to one in three children."
brochure:
How can I get the BEST HEALTH CARE for my child?

source:New York State Department of Health
file size: 2 pg.; languages: English
from the brochure:
"...A medical home is a way to provide high quality health care services that best meet the needs of children and families. It is not a building, house, or hospital...."
- also from New York State Department of Health:
  brochure:
  Getting the Health Insurance You Need - A Fact Sheet for Teens and Young Adults
  languages: English
  from the brochure::
  "...As a teen or young adult, it’s important to start thinking about what your health insurance choices are now, and how they might change as you get older. For example, your choices might change when you turn 18..."
web page:
New York Child Health Plus (SCHIP)

source:Benefits.gov
languages: English, Spanish
from the web page:
"New York State offers Child Health Plus as a health insurance plan for kids. Depending on your family's income, your child may be eligible to join either Child Health Plus A (formerly Children's Medicaid) or Child Health Plus B. Both Child Heath Plus A and B are available through dozens of providers throughout the state. Enrolling in Child Health Plus is easy..."
web page:
New York Public Health Insurance for Children

source:National Center for Children in Poverty
languages: English
from the web page:
"Eligibility Criteria... Benefits... Participants... Spending ..."
- also from National Center for Children in Poverty:
  web page:
  New York Public Health Insurance for Parents
  languages: English
bublication / brochure:
Children’s Health Coverage New York

source:Children's Defense Fund
languages: English
from the web page:
"New York provides health insurance coverage to children through two different programs: Childrenfs Medicaid, also known as Child Health Plus A, is a free, comprehensive health insurance program for lowincome children 18 years of age or younger living in New York State. There are no co]payments or premiums for Child Health Plus A..."
- also from Children's Defense Fund:
  brochure:
  Health Coverage for All Children: New York (2009)
  2 pages; languages: English
  from the brochure:
  "Health Coverage for New York’s Children:
  . 398,000 children are uninsured (8.4% of all children). *
  . 1.6 million children are enrolled in Medicaid. **
  . 384,000 children are enrolled in Child Health Plus B (NY’s CHIP program)...."
web page:
New York Medicaid, SCHIP, & Federal Authority

source:State Coverage Initiatives
languages: English
web page:
New York: CHIP Program Name and Type

source:Kaiser Family Foundation statehealthfacts.org
languages: English, Spanish
from the web page:
"Individual state profiles..."

New York Medicaid Medicaid Benefits and Coverage: Medicaid Services

web page:
Medical Assistance Program

source:City of New York, Human Resources Administration
languages: English
"...The following services may be paid for by Medicaid if all eligibility conditions are met. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan. You will not have a co-pay for most services if you are in a managed care plan..."
brochure or publication:
Women and Medicaid in New York

source:National Women's Law Center
3 pages; languages: English, Spanish
from the brochure or publication:
"Nearly one in five women in New York receives health care coverage through Medicaid.... Medicaid ensures that women in New York have access to a comprehensive set of important health care services... Women and Medicaid in New York: What Can Women’s Advocates Do?..."
web page:
(New York Medicaid) Benefits by State: (October 2008)

source:Kaiser Family Foundation
languages: English
from the web page:
"Medicaid benefits: Online database"
brochure or publication:
Mental Health and Substance Abuse Services in Medicaid and SCHIP in New York (2003)

source: US Dep't of Health and Human Services, Substance Abuse and Mental Health Services Administration
file size: 7 pg.; languages: English
from the brochure:
"In New York low-income children may be enrolled into the Medicaid program, an SCHIP Medicaid expansion program, or a Separate SCHIP program based on the child’s age and their family’s income....."
web page:
Medicaid and the Medicare Part D Prescription Drug Benefit

source:New York State Department of Health
languages: English
from the web page: "...Medicare Part D is a prescription drug benefit available to everyone with Medicare. It has special importance to people with Medicare and New York State Medicaid because Medicare Part D replaces Medicaid in paying for most of your prescription drugs ...."
- also from New York State Department of Health:
  web page:
  Medicaid Buy-in Program for Working People with Disabilities
  languages: English
  
  from the web page: "The Medicaid Buy-In program offers Medicaid coverage to people with disabilities who are working, and earning more than the allowable limits for regular Medicaid, the opportunity to retain their health care coverage through Medicaid..."
- web page:
  Family Health Plus (NOT a Medicaid program)
  languages: English
  
  from the web page: "Family Health Plus provides comprehensive health insurance coverage. When you choose a health plan, you will have a regular doctor, get regular checkups and see specialists, if needed. Coverage includes:..."
- web page:
  Medicaid Cancer Treatment Program: Breast, Cervical, Colorectal and Prostate Cancer (MCTP)
  languages: English
  
  from the web page: "The Healthcare Workforce Recruitment and Retention Act expanded Medicaid eligibility to certain individuals screened and diagnosed with breast and/or cervical cancer or pre-cancerous conditions through the Cancer Services Program Partnerships (CSPP)..."

New York State Medicaid Dental Services; Dentist

web page:
Find an Oral Health Provider: New York Dental Providers

source:InsureKidsNow.gov
languages: English

New York Medicaid Prescription Drugs; Preferred Drug List

brochure:
New York State Medicaid Generic Drug Program - A GUIDE FOR PEOPLE WITH MEDICAID AND FAMILY HEALTH PLUS

source:Magellan Medicaid Administration, Inc
1 page; languages: English
from the brochure: "...Medicaid will not pay for your brand name drug unless your doctor calls Medicaid to get approval, and writes the approval number on your prescription...."
- also from Magellan Medicaid Administration, Inc:
  brochure:
  New York State Medicaid Preferred Drug Program - A GUIDE FOR PEOPLE WITH MEDICAID AND FAMILY HEALTH PLUS
  languages: English
  
  from the web page: "...Remember: • All drugs that Medicaid currently covers are still available. • Only your doctor can decide which drugs you should take...."

New York Medicaid and Nursing Homes, Assisted Living

web page:
Consumer Guide to Community-Based Long Term Care

source:New York State Department of Health
languages: English
from the web page:
"...New York State has many services and programs as alternatives to nursing home care. Both medical and non-medical care may be received at home or in residential settings, and can range from simple (light housekeeping) to complex (nursing care or physical therapy) services..."
web site:The New York Long Term Care Care Project
New York Medicare Medicaid Nursing Homes Directory
languages: English
from the web page:
"These are New York Nursing Homes in cities A - Z." In addition to the state directory described above, there are nursing home directories for principal New York cities. A few examples:
New York Assisted Living
languages: English
from the web page:
"A consumer's guide to information and help about assisted living in New York, with a directory of assisted living facilities..."

New York Home Health Care Agencies
languages: English
from the web page:
"...a directory of 185 New York Home Health Care Agencies certified by and listed with Medicare at www. medicare.gov. ..."

New York Medicaid Waiver Programs

Medicaid Community Waivers in New York

"Medicaid home and community-based services [HCBS] are available through waiver programs to groups of individuals who would be eligible for Medicaid if institutionalized and, but for the services, would be institutionalized in a hospital or nursing facility. Under section 1915(c) of the Social Security Act, the federal government grants waivers of requirements that are otherwise applicable to Medicaid “state plan” services. "
*source: NY Health Access

for more information, see:

web page:
Medicaid Home-and-Community-Based Waiver Programs in New York State

source:NY Health Access
languages: English

More resources about New York Medicaid Waiver Programs:

web page:
Contact Info and Descriptions for all New York Medicaid 1915(c) HCBS Waivers, 2006

source:Center for Personal Assistance Services
languages: English
from the web page: "The following is a list of all New York 1915(c) Waivers by name - complete with a description, contact information and web link..."
web page:
Mayor's Office for People with Disabilities - Medicaid Waiver

source:NYC Mayor's Office for People With Disabilities
languages: English
from the web page:
"...People with Developmental Disabilities who are not covered by Medicaid can receive similar services by applying for a Medicaid waiver. Eligible persons and their families may apply for the following home and community-based services:..."

Report Medicaid Fraud in New York

brochure:
How to report Medicaid Complaints and Fraud Allegations

source:New York State Office of the Medicaid Inspector General
1 page; languages: English
from the brochure: "There are several ways to report an allegation or complaint..."
hotline:
Call Hotline Toll Free -
According to the New York State Office of the Medicaid Inspector General: "877-87FRAUD (877-873-7283) "

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New York Medicaid

topics: New York Medicaid: New York Public Health Insurance: medical coverage, centers for Medicaid; Medicaid In New York; Medicaid Assistance information; NY; definition Medicaid New York: New York Medicaid Eligibility: Applying for New York Medicaid: Medicaid: Health Programs for Children: CHIP:

About Medicaid in New York*

New York State Children’s Medicaid and Children's Health Insurance Program: