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Social Services

Breadcrumb Start you are here >Home/Medicaid

MEDICAID - 516-227-8000

What does
Medicaid pay for?
Medicaid FAQ (SSI) Supplemental
Security Income
Child Health
Plus
Family Health
Plus
Medical
Transportation
Home Care Skilled Nursing
Facility
Transitional
Medical Assistance
NYS Medicaid Link

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 Assistance and those that meet the eligibility criteria.

 Medicaid Pays for the Following:

  • In-patient care in hospitals
  • Out-patient care at hospitals
  • Physician services
  • Clinic services
  • Pharmacy
  • Skilled nursing home care
  • Long Term Home Health Care
  • Personal Care Aides
  • Child Teen Health Program
  • Mental Health
  • Family planning
  • Medical and health insurance Premium
  • Non-emergency medical transportation

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Medicaid FAQ

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 responsibility.
Supplemental Security Income (SSI) is a federal assistance program for the aged (65 and over), blind and disabled which is administered through local Social Security Offices. SSI beneficiaries are automatically eligible for Medicaid and may be eligible for Food Stamps and Emergency 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 Net Assistance.  Any Public Assistance applicant who reasonably appears to qualify for SSI, must apply for SSI and appeal any negative determination made by the Social Security Administration.

Questions about individual SSI claims should be addressed to the Social Security Administration at

1-800-772-1213 or you can view the Social Security web site for additional information.

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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:
  • well-child care
  • physical examinations
  • immunizations
  • diagnosis and treatment of illness and injury
  • X-rays and lab tests
  • outpatient surgery
  • emergency care
  • prescription drugs
  • inpatient hospital medical or surgical care
  • short-term therapeutic outpatient services (chemotherapy, hemodialysis)
  • limited outpatient treatment for alcoholism and substance abuse and mental health
  • dental care
  • vision care
  • speech and hearing
  • durable medical equipment

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Family Health Plus

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 Health Plus.

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What is Family Health Plus?

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 Health Plus.

What services are covered?

  • physician services; 
  • inpatient and outpatient health care; 
  • prescription drugs and smoking cessation products; 
  • lab tests and x-rays; 
  • vision, speech and hearing services; 
  • rehabilitative services (some limits apply); 
  • durable medical equipment; 
  • emergency room and emergency ambulance services; 
  • drug, alcohol and mental health treatment (some limits apply); 
  • diabetic supplies and equipment; 
  • radiation therapy, chemotherapy and hemodialysis; and 
  • dental 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 size.  Child Health Plus does not.

Will children who are in Child Health Plus have to transfer to Family Health Plus ?

No. 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.

What if an individual's income is too high for Family Health Plus?

You may be eligible for the Healthy NY program. Please contact Healthy NY at 1-866-HEALTHYNY (1-866-432-5849) or at their website:
http://www.ins.state.ny.us/healthny.htm

More Questions?

If you have any questions, please call 1-877-9-FHPLUS (1-877-934-7587).

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Medical Transportation

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.

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Home Care

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.

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Skilled Nursing Facility

Medicaid can pay for eligible individuals in a licensed skilled nursing facility.

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Transitional Medical Assistance

Transitional Medical Assistance (MA) provides continued medical assistance coverage to people who become ineligible for Family Assistance or medical 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:
  • new employment
  • increased earned income
  • 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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Related Links:

New York State
Department of Health
New York State DOH Consumer Page
New York State DOH Child Health Plus