Medicaid Eligibility in New YorkUpdated December 12, 2017 Medicaid
In New York, Medicaid is a healthcare option that is government sponsored and covers the medical expenses for patients who are low income and who could not afford healthcare otherwise.
New York’s Requirements for Medicaid Qualification
Eligibility for New York Medicaid is something that is determined by a few different factors that have been developed by the New York state department. The benefits given by Medicaid will aid those who are unable to pay their medical bills, such as those on SSI (Supplemental Security Income) and others who meet the requirements for eligibility. Before those requirements even come in to play though, you first have to fall into one of the following categories:
- Adults who have an income that does not exceed 138% of the FPL (Federal Poverty Level)
- Infants and/or women who are pregnant whose income does not exceed 218% of the Federal Poverty Level
To qualify for Medicaid - aside from being in one of the preceding two categories - you need to meet predetermined requirements for eligibility. You have to reach, without exceeding certain income thresholds. Additionally, you have to prove that you are a citizen of the US as well as proving that you are a state resident. You also need to have documentation regarding your living situation and your marriage license if you are married, along with your SSN (Social Security Number).
How to Apply for Medicaid in in New York
Due to the fact that you must stick to specific instructions with regards to submitting your paperwork, the application guidelines are different in New York than those in other states. The qualifying criteria are actually spread into two separate groups. These are MAGI (Modified Adjusted Gross Income) and non-MAGI groups. You have to file differently depending on which group you fall into.
When it comes to MAGI application guidelines, this group includes foster children, children under 19, 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, you will have to apply for the Medicaid program via the New York State Department of Health Marketplace.
To be eligible under the non-MAGI eligibility group, you must be a recipient of one of the following:
- Medicaid Cancer Treatment Program
- AIDS Health Insurance Program
- Social Security Income
- ADC-related medical needy, or the
- Medicare Savings Program
If you belong to this group, you should apply for Medicaid at your local Department of Social Services.
The New York Medicaid Application can be filed online, in person, by mail, or on the phone. If you decide to apply in person, you may do so at the District Service Office in your area. If you decide to file by mail, simply download and fill out the application and then 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 for the proper phone number for your area. Make sure that you have all of the information that you will need on hand before calling to file an application.
What Does Medicaid Cover in New York?
Medicaid gives beneficiaries quite a broad range of coverage with regards to health insurance. This includes visits to the doctor, hospital stays, care in a nursing home, home health care, and more.
Medicaid also pays for prescriptions. If you ever have to pay a copay, it will be one that is relatively small.
Income Requirements for New York Medicaid
The income requirements for Medicaid are based on various resource levels for the state. For example, the income requirements for people who are over the age of 65, blind, or otherwise disabled are different than they are for people who are single or who are married but without any children. Additionally, assets are to be accounted for. When it comes to getting around the Medicaid financial requirements, you can only have more money if you are over 65, a child, pregnant, blind, or otherwise disabled.
In general, you can only have income that is not over 138% of the FPL for your size family or household. If you would like to see specifics as far as what you can earn for your household size, click here.
How Much Does Medicaid Cost in New York?
Medicaid coverage allows for families with a low income as well as low-income individuals to get quality and affordable healthcare. Some of the services offered by Medicaid are free, but others will require co-payments that can vary.
Cost and Coverage of Medicaid in New York
Estimates for the cost of Medicaid can vary depending on things like the individual patient and services needed. These copays will be small. People who will receive free healthcare from Medicaid include those who are under the age of 21, women who are pregnant, and patients who are in long-term care.
As far as coverage goes, Medicaid typically pays for most medical services, along with any medications and supplies that are needed. This includes coverage for things like:
- Family planning services and prenatal care
- Ambulance rides to the hospital in emergency situations
- Public transportation or car mileage to the patient’s medical appointments
- Medicines, supplies, medical equipment, and appliances
- Early screening, diagnosis, and treatment for beneficiaries who are under 21
- Other various services that might be needed
Prescription Drugs with Medicaid in New York?
New York Medicaid does pay for prescription drugs. There might be a small copay depending on the drug and the benefits of the patient.
Which Medicaid plan is best in New York?
The best option when it comes to Medicaid in New York comes down to which one you qualify for. You might only qualify for one and that is the one you will get. If you have an option, it is best to discuss the options with your caseworker once you have been approved.