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Medicaid
With the implementation of the Affordable Care Act in 2014, applicants in the MAGI category listed must apply through New York State of Health by calling 1-855-355-5777.
The following people are eligible to apply through New York State of Health:
- Pregnant women,
- Infants and children,
- Parents/Caretaker Relatives,
- Adults aged 19- 64 years old,
- Those who are disabled but NOT on Medicare,
- Small businesses and consumers not eligible for Medicaid
The New York State of Health Marketplace provides access to all insurance programs, including Medicaid, Child Health Plus and private health plans. Those with incomes too high to qualify for Medicaid can buy subsidized health insurance plans through the Marketplace.
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 Supplemental Security Income (SSI), public assistance, SNAP and those that meet the eligibility criteria.
Medicaid pays for the following:
- Child Teen Health Program
- Clinic services
- Family planning
- In-patient care in hospitals
- Long term home health care
- Medical and health insurance premium
- Mental health
- Non-emergency medical transportation
- Out-patient care at hospitals
- Personal care aides
- Pharmacy
- Physician services
- Skilled nursing home care
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 SNAPand 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.
Child Health Plus (MAGI)
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.
- Outpatient surgery
- Physical examinations
- Prescription drugs
- Short-term therapeutic outpatient services (chemotherapy, hemodialysis)
- Speech and hearing
- Vision care
- Well-child care
- X-rays and lab tests
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 July 1, 2015 you must contact LogistiCare Solutions, the New York State Department of Health's transportation coordinator, at 1-844-678-1103. 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 LogistiCare Solutions at 1-844-678-1103 for prior approval of reimbursement..
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.
Skilled Nursing Facility
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 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.