MEDICAID - 516-227-8000
Medicaid provides assistance to people who do not
have the means to pay for medical care. People
who are eligible include people in receipt of SSI (Supplemental
Security Income), Public
and those that meet the eligibility criteria.
Pays for the Following:
care in hospitals
care at hospitals
nursing home care
Term Home Health Care
Teen Health Program
and health insurance Premium
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For current Medicaid beneficiaries:
For those subject to a resource test:
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What if I do not agree with the agency’s decision regarding my eligibility?
If you think the agency’s decision is wrong, you can request a review of the decision. You can request a conference or ask for a State Fair Hearing. You can also do both of these things. Information on requesting either a conference or a Fair Hearing can be found on the written notice you received regarding your eligibility or by clicking on the link above “How do I request a Fair Hearing?”
The doctor’s office stated my Medicaid is not active. What do I do?
If you were told by your doctor’s office that your Medicaid is not active, you should first check with your Managed Care Plan to be sure you are no longer covered. If you do not have coverage with your plan, contact your DSS worker to find out the reason your Medicaid is not active. If your case was closed and you have received a notice advising you of the reason your Medicaid would close with an effective date, it may be necessary for you to reapply in order to restore your benefits.
Supplemental Security Income (SSI)
All SSI recipients are eligible for Medicaid automatically. The
district they reside in will be the district of financial
Supplemental Security Income (SSI)
is a federal assistance program for the aged (65 and
over), blind and disabled which is administered through
. SSI beneficiaries are
automatically eligible for Medicaid and may be eligible
Assistance to Adults (EAA)
as well as other
services through the local district offices. A small
number of SSI recipients, whose available income is less
than the applicable public assistance standard, may be
eligible for Safety
. Any Public
applicant who reasonably appears
to qualify for SSI, must apply for SSI and appeal any
negative determination made by the Social
Questions about individual SSI
claims should be addressed to the Social
Security Administration at
1-800-772-1213 or you can view
Security web site for additional information.
Child Health Plus
New York State has a health insurance plan for children
under 19 years of age. The Medicaid program must
evaluate every child's eligibility for Medicaid (Child
Health Plus A
), and those not eligible will be evaluated
by the provider for Child Health Plus B. The toll
free number for information on the program is 1-800-698-4543. This
health insurance plan is available throughout the state
and covers the following services:
and treatment of illness and injury
and lab tests
hospital medical or surgical care
therapeutic outpatient services (chemotherapy, hemodialysis)
outpatient treatment for alcoholism and substance abuse
and mental health
In December 1999, Governor George
E. Pataki signed into law the Health Care Reform
Act of 2000 which expands quality health care coverage
to nearly one million uninsured New Yorkers under Family
What is Family Health Plus?
provides health coverage
to adults who do not have insurance through their employers,
but have income too high for Medicaid.
Who can join?
Parents and childless adults aged 19 through 64 are
eligible if they live in New York State, have no health
insurance coverage and have income at or below the eligibility
levels established by the New
York State Department of Health.
How much does it cost to join?
There is no cost to participate in Family
What services are covered?
and outpatient health care;
drugs and smoking cessation products;
tests and x-rays;
speech and hearing services;
services (some limits apply);
room and emergency ambulance services;
alcohol and mental health treatment (some limits apply);
supplies and equipment;
therapy, chemotherapy and hemodialysis; and
services (if offered by the plan).
How is care provided?
Once applications are available, health care will be
provided through managed care plans. Family Health Plus
will do its best to help participants continue to see
their current doctor.
How does a person enroll in Family Health Plus?
Enrollment facilitators and local social services district
offices will help people enroll, answer their questions,
and also help people choose a health plan.
How does a person know when to apply?
This website will be updated to let people know when
they can apply for Family Health Plus. In addition, there
will also be an advertising campaign.
Can a person drop health insurance to join this program?
No. Family Health Plus is a health care program for
persons who do not already have health insurance.
If my children are in Child Health Plus, does that mean
I'm eligible for Family Health Plus?
Not necessarily. Family Health
Plus has maximum income levels depending on household
Child Health Plus does not.
children who are in Child Health Plus have to transfer
to Family Health Plus ?
Children will still be covered under the Child
Health Plus program. Child Health Plus is a program
for children, and Family Health Plus is a program for
adults. Family Health Plus will do its best to help
parents enroll in the same plan as their children.
if an individual's income is too high for Family Health
may be eligible for the Healthy NY program. Please
contact Healthy NY at 1-866-HEALTHYNY (1-866-432-5849)
or at their website:
If you have any questions, please call 1-877-9-FHPLUS
Medicaid can pay for transportation to and from emergency medical care and services. Medicaid can also pay for transportation to and from Medicaid billable non-emergency medical care or services for a Medicaid eligible individual or reimburse that individual for the expense related to public transportation or private vehicle use.
In non-emergency situations, prior approval of the Department is required to ensure that:
- the mode of transportation, (i.e. private vehicle, public transit, taxi, ambulette, ambulance) is appropriate to the medical needs of the client.
- the least costly appropriate transportation is arranged.
If your medical condition requires you to travel by taxi, ambulette or ambulance, effective January 1, 2012 you must contact Logisticare Solutions, the Department's transportation coordinator, at 1-877-813-5602. If you are hearing impaired (TTY) please call 1-866-288-3133. If you are traveling by private vehicle or public transit, you must contact the Department's Medical Services Unit at 516-227-8070 for prior approval of reimbursement.
Medicaid can pay for approved licensed personal care
and home health care services for people financially
eligible for Medicaid. To have this service approved
requires a nursing assessment.
Medicaid can pay for eligible individuals in a licensed
skilled nursing facility.
Transitional Medical Assistance
Transitional Medical Assistance (MA)
provides continued medical assistance coverage to people
who become ineligible for Family
assistance with budgeting and who have a dependent child
under the age of 21 living with them. Transitional
MA benefits are available for six months to those who
lose family assistance due to:
- loss of earned income disregards
An additional six months of medical
assistance may be possible if the person remains employed;
has earned income below
certain levels; and has a dependent child under the age
of 21 living with them.
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Department of Social Services General Information: (516) 227-8519
New York State
Department of Health
New York State DOH Consumer Page
New York State DOH Child Health Plus