Medicaid in New York is a comprehensive public health insurance program designed to provide essential medical services to residents who meet certain income and eligibility requirements. It covers many services, including hospital care, laboratory and X-ray services, nursing home care, and many others. The program caters to various groups, including children, pregnant individuals, adults, and those with disabilities. Applications for Medicaid can be made through the NY State of Health Marketplace, local Department of Social Services offices, or Managed Care Organizations, ensuring accessible healthcare for those in need.

Medicaid in New York covers a range of health services, although specific coverage can vary based on factors like age, financial situation, family circumstances, and living arrangements. Some services require small co-payments.

Here's a summary of the covered services:

• Smoking Cessation Agents: Assistance with quitting smoking.
• Health and Dental Care: This includes preventive and treatment services from doctors and dentists.
• Hospital Services: Both inpatient and outpatient services are covered.
• Laboratory and X-ray Services: Diagnostic services such as lab tests and X-rays.
• Nursing Home Care: Services provided in a nursing home setting.
• Home Health Agencies and Personal Care: Includes care provided at home by health agencies and personal care aides.
• Psychiatric Hospital Treatment: For individuals under 21 or those 65 and older, as well as care in mental health facilities for those who are developmentally disabled.
• Family Planning and Reproductive Health Services: This includes various family planning and reproductive health services.
• Child/Teen Health Program: Early periodic screening, diagnosis, and treatment for children under 21.
• Medicines, Supplies, Medical Equipment, and Appliances: This includes items like wheelchairs.
• Clinic Services: Services provided in a clinic setting.
• Transportation to Medical Appointments: This can include public transportation and car mileage.
• Emergency Ambulance Transportation: To a hospital in case of an emergency.
• Prenatal Care: Health services related to pregnancy.
• Vision Care and Eyeglasses: Services related to eye health.
• Insurance and Medicare Premiums: Some premiums might be covered.
• Other Health Services: Various other health services as required.

Additionally, Medicaid recipients receive a Benefit Identification Card, which must be presented to receive medical services. Prior approval might be needed for certain supplies, equipment, or services before they can be provided.

Eligibility for Medicaid in New York is determined using Modified Adjusted Gross Income (MAGI) rules, similar to IRS rules with minor variations. Here's a summary of the key eligibility criteria:

MAGI Eligibility Groups

• Adults aged 19-64 who are not eligible for Medicare
• Children aged 1-18
• Infants under age one
• Pregnant individuals
• Parents and caretaker relatives of any age who have Medicare

Non-MAGI Eligibility Groups

• Individuals aged 65 and older who are not a parent or caretaker relative
• Blind or disabled individuals who don't meet any MAGI group criteria
• Residents of adult homes run by LDSS, OMH, Residential Care Centers/Community Residences
• Eligible for specific programs including Medicare Savings Program, COBRA, AIDS Health Insurance Program, Medicaid Buy-in for Working People with Disabilities, Foster care/former foster care youth, and those screened for Presumptive Eligibility

Other Factors Influencing Eligibility

• State residency
• Citizenship or immigration status
• Family or household size
• Income: Proof may be required to process applications

View income level chart here.

Applying for Medicaid in New York can be done through several channels:

NY State of Health: The Official Health Plan Marketplace

You can apply for Medicaid through the Official Health Plan Marketplace. Free personalized help is available from Enrollment Assistors. Contact the Marketplace Customer Service Center at (855) 355-5777 for assistance. For TTY users, the number is 1-800-662-1220.

Through a Managed Care Organization (MCO)

You can apply for Medicaid via a Managed Care Organization. For more information or assistance, call the Medicaid Helpline at (800) 541-2831.

Local Department of Social Services Office

You can also apply for Medicaid by visiting or contacting your local Department of Social Services office.

Each option provides a pathway to apply for Medicaid, with assistance and guidance available through the process.

Renewing Medicaid in New York typically involves an annual process, but the exact procedure depends on how your Medicaid is managed. Here's a summary of the key points:

Annual Renewal

Most Medicaid renewals in New York occur once a year. You'll receive a notice from Medicaid when it's time to renew.

Renewal Through Local Department of Social Services (LDSS)

If LDSS manages your Medicaid, you'll receive a renewal packet in the mail before your renewal date. The packet will include information on recertification, including phone or internet renewal options.

Renewal Through NY State of Health

For those whose Medicaid is managed by the NY State of Health, many renewals are handled automatically by Medicaid, requiring no action from you. If action is required on your part, you will be notified accordingly. It's important to respond and provide any requested documentation to avoid gaps in coverage.

Medicaid correspondence cannot be forwarded by the post office. If you've changed your address, you must notify your Medicaid office directly to ensure you continue to receive all necessary notices.