How to Qualify for Medicaid in New York
Medicaid in New York is a government sponsored healthcare option that covers the medical expenses for low-income patients who otherwise could not afford healthcare, such as those on SSI (Supplemental Security Income) and others who meet the requirements for eligibility.
The New York state department developed eligibility requirements for New York Medicaid, and it starts with determining if a person falls into one of the following categories: adults who have an income that does not exceed 138% of the FPL (Federal Poverty Level), and infants and pregnant women whose income does not exceed 218% of the FPL.
To qualify for Medicaid in New York, besides needing to be in one of those two categories, you need to meet predetermined requirements for eligibility:
- You have to reach, without exceeding certain income thresholds.
- You have to prove that you are a citizen of the U.S., as well as a state resident.
- You need to have documentation regarding your living situation; your marriage license if you are married; and your SSN (Social Security Number).
The application guidelines are different in New York than those in other states. The qualifying criteria are spread into two separate groups – MAGI (Modified Adjusted Gross Income) and non-MAGI, with application guidelines depending on which group you fall into.
The MAGI group includes children under 19, foster children, beneficiaries of the FPBP (Family Planning Benefit Program), relatives of caregivers or parents, women undergoing fertility treatments and pregnant women. If you fall into this group, apply for the Medicaid program via the New York State Department of Health Marketplace.
The non-MAGI eligibility group includes the following:
- Medicaid Cancer Treatment Program
- AIDS Health Insurance Program
- Social Security Income
- ADC-related medical needy
- Medicare Savings Program
Pregnant women, children, disabled persons, and others may be eligible for Medicaid if their income is above the set levels and they have medical bills – ask your Medicaid worker if you fit into one of these groups.
Individuals who are certified blind, certified disabled, or age 65 or older who have more resources may also be eligible.
You can file the New York Medicaid Application online, in person with a navigator or certified application counselor, by mail, or on the phone. To apply in person, go to the District Service Office in your area. To file by mail, simply download and fill out the application and send the completed application to the District Social Service office in your area. To apply by phone, call the New York State Department of Health to get the right number for your area; make sure you have all of the information that you’ll need on hand before calling to file an application.
After you complete the Access NY Health Care application (DOH-4220), you may assign a representative who can apply for and/or renew Medicaid for you, discuss your Medicaid application or case and/or allow them to get notices and correspondence. To authorize or change a representative at renewal or anytime in between renewals, you may fill out the form DOH-5247 and submit it with your renewal.
People who receive Medicaid have privacy rights. The Medicaid application, Access NY Health Care, contains your rights under “Terms, Rights and Responsibilities.”
If you are dissatisfied with a decision made by the local social services district, you may request a conference with the agency, and you may also appeal to the New York State Office of Temporary and Disability Assistance and request a Fair Hearing.
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