Getting Started in Medicaid

Overview

Medicaid is the public health insurance program for people of limited means. It is jointly funded by the Federal, state, and local governments. However, each state has its own Medicaid program, with completely different rules regarding eligibility and what services are covered. You should assume that any information provided on this website only applies to the New York State Medicaid program (also known as "Medical Assistance").

Generally speaking, New York's Medicaid program is comprehensive health coverage, including doctor's visits, hospitalizations, prescription drugs, home care, nursing home, and much more.

Eligibility for Medicaid depends on the applicant's income, assets (known as "resources"), immigration status, residence, and category. There are different categories of Medicaid (with different financial eligibility rules) depending on whether the applicant has minor children, is disabled, or over 65 years old.

Category

To get Medicaid, you must apply at the Department of Social Services (DSS) in your county. In New York City, the Human Resources Administration is the DSS for all five boroughs. There are special offices in every borough where you can apply for Medicaid.
Category

The first thing you need to know to determine whether you're eligible for Medicaid is your category. There are several different categories of Medicaid in New York, each with different rules:

AFDC-Related

This category generally applies to a parent or other caregiver of children under 18, 19- and 20-year-olds, and pregnant women.  There is a similar category called Low Income Families (LIF) that is used in some cases.

Disabled, Aged, or Blind (DAB)

This category is sometimes called SSI-related. This category applies to those who are over age 65, unable to work due to a physical or mental impairment, or blind.

Singles or Childless Couples (S/CC)

This category is the catch-all for those who do not fit one of the other categories. You must have much lower income and resources to be eligible for Medicaid if you are in this category.

Now that you know which category you are, you will know the appropriate income limit.

Income

To be eligible for Medicaid, your monthly income must be below a certain threshold. You can look up the income limits for the various categories in this chart.  There are some types of income that Medicaid does not count. Some applicants will be able to get Medicaid in spite of having too much income by using the spend-down program. Medicaid does not only count the applicant's income, but also the income of other people in the applicant's household. Which other household members are counted depends on the category of Medicaid.

Resources

To get Medicaid, you also have to have assets (or "resources," as they are called in Medicaid jargon) below a certain threshold. As with income, each category of Medicaid has different resource limits, there are some resources that are not counted, and the resources of other household members may be counted.

Immigration Status

In New York State, you do not need to be a citizen or green-card holder to get Medicaid. However, if you are totally undocumented, you will probably not be eligible for Medicaid. Even undocumented immigrants, however, can get Medicaid to cover certain emergency services.

Residence

You must be a resident of New York State to get New York Medicaid. Medicaid eligibility does not transfer from state-to-state. If you move to a new state, you will have to re-apply. In addition, New York Medicaid does not usually cover services you receive while temporarily out of the state. In addition to state residence, your Medicaid case belongs to a particular county. If you move to a new county, you will not have to re-apply, but will have to notify Medicaid that you moved.

For more information on Medicaid eligibility, see our memo on Basic Eligibility for Medicaid Home Care. (also in Spanish)

Applications and Documentation

DOH published a new Documentation guide, including a guide to verifying citizenship and immigration status.  The guide is Attachment 3 of 09 INF-02 - Revised DOH-4220: ACCESS NY Healthcare Application (March 23, 2009).   

In April 2010, DOH has posted a new version of the ACCESS NY Application (Feb. 2010) that appears to be usable by ALL Medicaid recipients, including age 65+, disabled, and blind.  Previously, that application was a shortened application used for some public health insurance programs -- but not for Medicaid for people age 65+, disabled, or blind, who still had to complete the Form 2921 (green application).  These Medicaid recipients must also complete Supplement A of the application.

All of these new documents are, confusingly, posted on the Family Health Plus webpage, but the Medicaid webpages link back to this page--http://www.health.ny.gov/health_care/family_health_plus/application.htm.    On that page, are the following application documents.   

APPLICATIONS  for AGE 65+, BLIND AND DISABLED -- must submit both the APPLICATION and SUPPLEMENT A 

Services Covered

What are some reasons why people need Medicaid?

• No employer-based health insurance and cannot afford to pay for individual health insurance
• Medicaid is the only insurance that covers long-term home health care or nursing home care
• Was uninsured and then became sick/injured and needed medical coverage

This article was authored by the Evelyn Frank Legal Resources Program of Selfhelp Community Services, Inc.