Medicaid is a subject that is discussed daily by millions, but there are still countless individuals that have questions about what exactly Medicaid is, who is eligible, and how to apply. If you have questions like these, you will be able to find all the information you need, right here.
How can I apply for Medicaid?
There are several ways that you can apply for Medicaid through the state of New York. You can apply in writing, by phone, or by going to the online application portal at nystateofhealth.ny.gov.
If you are located within New York City, you can apply by calling the Human Resources Administration at (718) 557-1399.
The method of application that you use will also depend on your category. Your category will be either a single person, pregnant woman, childless couple, parents or caretaker relatives of dependent children, the elderly, and the disabled. Some categories will apply by using the New York State of Health Marketplace, while others will need to reach out to their Local Department of Social Services office to apply. Those needing coverage who reside in a state operated facility will have more specific contacts.
If the individual falls under one of the following categories, they should apply via the New York State of Health Marketplace:
● Adults of ages 19 to 64 who are not eligible for Medicare
● All pregnant women and infants
● Children ages 1 to 18
● Parents & related caretakers of any child 18 years of age or younger
If the individual needing coverage falls under one of the following categories, they should apply via their Local Department of Social Services or LDSS:
● People 65 or older who are not already categorized as caretaker relatives
● People whose eligibility is based on their status as a blind or disabled person, or those to request officially; this will include individuals that choose to request coverage specifically for community based long term care services (CBLTCS), consumer directed personal assistance services (CDPAS), or personal care services (PCS)
● Participants in the Medicare savings program, or MSP
● MBI-WPD, or the Medicaid Buy-In for those enrolled in the Working People with Disabilities program
● Any New York residents who were part of the foster system at any point
Pregnant women and those applying for Medicaid for children can apply at many New York clinics, hospitals, and healthcare provider offices. You can also speak to your local Department of Social Services office, and they can generally provide you with more information and direction on whom to speak to regarding applying for coverage.
If you or the individual you care for are in a facility operated by the New York State Office of Mental Health, contact the patient resource office for Medicaid application information and assistance.
If you or the individual you care for are in a facility certified by the New York State Office for People With Developmental Disabilities, contact the revenue and reimbursement office for information and help with applying for Medicaid.
What is Medicaid?
Medicaid is a joint federal & state program that pays for medical assistance for individuals and families with low incomes and relatively few assets. Medicaid is considered to be America’s public health insurance program, and is used by approximately 1 in 5 Americans. It helps to provide health insurance coverage to millions of low-income adults and other eligible individuals.
Who is eligible for Medicaid?
You may be eligible for Medicaid coverage under a wide range of conditions, and relatively generous income requirements. You may be eligible for Medicaid if you are a single individual or childless couple that has income below the stated income thresholds.
Pregnant women are also able to be covered under a process called Presumptive Eligibility, which will ultimately be processed by their LDSS. This also extends to those who are guardians or otherwise responsible of any child between the ages of 1 and 18.
Medicaid coverage is also available to those that are considered disabled, or live in a household with someone with a disability. Medicaid eligibility is also granted to anyone 65 years of age or older that does not have other insurance. The income requirements for families and individuals who are disabled, blind, or aged 65 or older.
Medicaid Income & Resource Thresholds
| Family Size | Income threshold for singles and childless couples | Income threshold for families and individuals disabled, blind, or 65 or older | Resource threshold for disabled, blind, or 65+ individuals | ||
| 1 | Per Year | Per Month | Per Year | Per Month | |
| 2 | $17,775 | $1,482 | $10,600 | $884 | $15,900 |
| 3 | $24,040 | $2,004 | $15,600 | $1,300 | $23,400 |
| 4 | $30,305 | $2,526 | $17,940 | $1,495 | |
| 5 | $42,836 | $3,570 | $22,620 | $1,885 | |
| 6 | $49,101 | $4,092 | $24,960 | $2,080 | |
| 7 | $55,366 | $4,614 | $27,300 | $2,275 | |
| 8 | $61,631 | $5,136 | $29,640 | $2,470 | |
| 9 | $67,896 | $5,658 | $31,980 | $2,665 | |
| 10 | $74,162 | $6,181 | $34,320 | $2,860 | |
| Each additional individual adds: | $6,266 | $523 | $2,340 | $195 |
Data current for 2021, but subject to annual review and adjustment.
What do I need to fill out to apply for Medicaid?
If you believe you may be eligible for Medicaid coverage and would like to apply online or with a printable form, you can use the official New York Department of Health application.
Depending on the category you belong to, your application may need to be accompanied by the appropriate documentation showing your Modified Adjusted Gross Income. Categories that will have their eligibility dependent on their income will include:
● Pregnant women and infants
● Children under 19 years of age, whether currently in foster care or not
● Childless adults between the ages of 19 and 64, disabled or not, who are not currently on Medicaid
● Parents and caretaker relatives
For More Information
If you still have questions or concerns regarding Medicaid eligibility, access, or application for you or a loved one, you can speak with a representative from the New York State of Health Marketplace at (855) 355-5777 (TTY: (800) 662-1220).