Medicaid is a government program that provides medical care for millions of low-income individuals across the country. Although it is federally funded, the program is administered at the state level, which means that each state is free to implement its own rules and eligibility requirements. Here’s everything you need to know about Medicaid benefits and the application process if you live in Buffalo, New York.
How Do I Apply For Medicaid in Buffalo?
Applying for Medicaid in Buffalo is simple if you are eligible for the program and you understand the basic qualification requirements. You may receive Medicaid coverage in Erie County if you belong to one of the following categories:
- Families with a yearly income of less than $23,550 (for a household of 4 individuals)
- Pregnant women
- Children
- Disabled individuals
- People who are unemployed and their families
- Seniors over the age of 65 with or without a medical condition.
You should keep in mind that if you already have another type of health insurance, you are not required to cancel it before applying for Medicaid. Medicaid may pay the premiums on your existing policy if you qualify, although your eligibility will depend on several different factors.
If you live in Buffalo, you can choose to apply for Medicaid in person, by post, by phone, or online.
Applying in person
To apply for Medicaid in person, you should visit the Erie County Work Center.
Address:
Erie County Work Center (Department of Social Services)
158 Pearl Street
Buffalo, NY 14202
Office hours: Monday-Friday 9 am – 4 pm.
Phone: (716) 858-6244
Website: Erie County Work Center
The center offers information about Medicaid and provides assistance with the Medicaid application process. You can also visit the Erie County Work Center if you wish to apply for the Family Planning Benefits Program or the Medicare Savings Program at the same time as Medicaid in order to receive additional benefits and coverage.
The in-person application process for people over the age of 65 and disabled individuals requires completing the DOH-4220 form. The form can be obtained by calling (855) 355-5777 or downloaded online.
Applying by mail
You can submit your Medicaid application by mail to the following address:
Erie County Work Center
PO Box 120
Buffalo
NY 14201-9903.
The Medicaid application form can be downloaded here. The application booklet includes the list of the required documentation (proofs of age, residency, income, insurance, disability, etc.) and detailed instructions on how to fill out the form.
Applying online
Individuals under the age of 65 who are not disabled can apply for Medicaid online, through the New York State Department of Health Plan Marketplace.
Applying by phone
Applying for Medicaid by phone can also be done through the New York State Department of Health Marketplace.
Phone: (855) 355-5777
TTY: (800) 662-1220 for hearing impaired
Office hours: Monday – Friday 8 am – 8 pm, Saturday 9 am – 1 pm.
The Marketplace provides services of Navigators and Certified Application Counselors (CAS) who can assist you in your Medicaid application process free of charge. You can find the list of assistors in Erie County through the Marketplace Navigator Directory. The assistors are culture sensitive and offer help in several different languages at convenient times, including evenings and weekends.
Medicaid Managed Care Program
Managed care is a health care delivery system where Medicaid contracts with Managed Care Organizations (MCOs) to deliver its services to beneficiaries, thus allowing the state to reduce Medicaid program costs. These plans provide most regular Medicaid services, with the exception of pharmacy and dental services that are always offered through the traditional Medicaid system.
If you are a Medicaid-eligible individual in Erie County, you are required to enroll in a Managed Care plan, unless you belong to an exempt category (Native Americans, providers not geographically accessible) or are excluded (individuals who are dually eligible for Medicaid/Medicare, those who are covered under other insurance, and more). You can apply for Medicaid directly through a managed care organization.
For more information about the Medicaid Managed Care, call New York Medicaid CHOICE enrollment program at (585) 753-6702 or (800) 505-5678.
What Services Does Medicaid Provide for Residents in Buffalo?
New York has relatively liberal laws when it comes to Medicaid coverage. The program covers not only essential health care services for Erie County residents, but includes a number of supplemental benefits that may not be available in other states.
Mandatory Medicaid benefits
Mandatory Medicaid benefits are common for all states. They include:
- Regular medical checkups and follow-up care
- Laboratory tests and X-ray services
- Medicine, medical supplies, and medical equipment such as wheelchairs, canes, and crutches
- Immunizations
- Drug prescriptions for the cheapest drug options
- Smoking cessation agents
- Emergency care
- Hospital inpatient and outpatient services
- Family planning (birth control) services
- Prenatal care
- Early periodic screening, diagnosis, and treatment for children
- Treatment in psychiatric hospitals, mental health facilities, and facilities for the mentally retarded or the developmentally disabled.
Additional New York Medicaid services
In addition to mandatory benefits, New York Medicaid offers a wide range of supplemental health services to its residents, such as some non-prescription medications, essential dental, auditory, and vision care including eye exams, medically necessary eyeglasses, and contact lenses. Note that dental, auditory, and vision benefits are covered as long as you visit a Medicaid-approved medical practitioner in Erie County.
Services that are not covered by Medicaid in the State of New York, including Erie County, are some over-the-counter medications, missed appointments, cosmetic surgeries, and medical services that are provided outside of the US.
Medical transportation
New York Medicaid covers both emergency and non-emergency medical transportation to and from medical care and services for Erie County residents. This can be anything from public transportation to personal vehicles, taxis, wheelchair vans, and ambulances. The approval of the Department of Social Services is required to ensure that the mode of transportation is appropriate to the patient’s medical needs and that the least costly appropriate transportation is used.
Buffalo has several medical transportation providers, for example:
289 Ramsdell Ave. Buffalo, NY 14216
Phone: (716) 877-5600
Email: gary@buffalotrans.com
30 Horton PlBuffalo, NY 14209
Phone: (716) 446-3623 (24/7)
Email: info@buffalomedicaltaxi.com
3385 Bailey Ave, Buffalo, NY 14215
Phone: (716) 986-2539
Please note that these providers offer only non-emergency transportation. For emergency medical transportation, please call 911.
Consumer Directed Personal Assistance Program (CDPAP)
The Medicaid Home Care Services program allows New York Medicaid beneficiaries to stay at home while receiving care instead of having to live in a nursing home or assisted living facility.
For eligible individuals, Medicaid covers the cost of the following:
- Assisted living programs
- Personal care attendants
- Housekeeping
- Home health aides
- Personal emergency response systems.
In addition, people on Medicaid can benefit from the Consumer Directed Personal Assistance Program (CDPAP) if they have a stable medical condition but still need help with activities of daily life and/or skilled nursing care. CDPAP allows New York residents to hire and manage their own home care aides. Almost anyone among the beneficiary’s family members and friends can be hired as a home care assistant and is paid for their services through CDPAP. In order to qualify, the beneficiary or a designated representative acting on their behalf must be capable to direct the home care according to the CDPAP regulations.
Location of Medicaid Offices in Buffalo
The Medicaid office in Buffalo is located in the Erie County Working Center:
Erie County Work Center (Department of Social Services)
158 Pearl Street
Buffalo, NY 14202
Office hours: Monday-Friday 9 am – 4 pm.
Phone: (716) 858-6244
Website: Erie County Work Center
You may want to contact the Medicaid office in Buffalo in person if you:
- Have any questions regarding your Medicaid eligibility
- Need assistance to fill out your Medicaid application form
- Wish to renew your Medicaid enrollment
- Were denied Medicaid benefits
- Need to show proof that you are enrolled in Medicaid.
Before visiting the office, you should call and schedule an appointment. Make sure to bring the necessary documentation to prove that you meet the requirements to enroll in Medicaid.
If you’re not sure whether you qualify for Medicaid, you can schedule an interview with an Erie County Work Center representative who will help you determine your eligibility.
If you don’t want to visit the Erie County Department of Social Services or if you live far away, you can also go to one of the locations below for help with applying for Medicaid:
298 Main Street
Buffalo, NY 14202
Phone: (888) 630-2583 or (800) 628-2777
350 Main Street
Buffalo, NY 14202
Phone: (716) 849-4960
205 Park Club Lane
Buffalo, NY 14221
Phone: (716) 847-1480
General inquiries about Medicaid
If you have any general, non state-related questions about Medicaid or if you wish to provide feedback about the program or report fraud, contact the Center for Medicare and Medicaid Services in Baltimore, Maryland.
Phone: (877) 267-2323
Email: medicaid.gov@cms.hhs.gov
Website: www.medicaid.gov