Millions of people all across the United States rely on Medicaid for their health coverage. The program is designed for low-income adults, people with disabilities, and older adults, among others.
Medicaid is sponsored by the government to provide coverage to low-income patients who aren’t able to afford medical care otherwise. It is run jointly by both the state and federal governments.
If you live in New York, this article will be an easy to understand guide covering all you need to know about Medicaid in NY.
We will discuss eligibility requirements, what proof you need, the benefits you can receive if eligible, and more.
Eligibility requirements for Medicaid in NY
Since Medicaid is designed for low-income individuals and families, there are specific income and asset requirements that you must meet, depending on various factors, as we will discuss below.
To be eligible for Medicaid in NY, you must also meet the following eligibility criteria.
- You must be a U.S. national, citizen, permanent resident, or legal alien.
- You must be a resident of New York.
- You (or eligible members of your family) must need help with medical care/insurance coverage.
- Your financial situation must fall within the low-income category (more details below).
In addition to these requirements, you must also be one of the following:
- Have a member of your family/household with a disability
- Be responsible for a child 18 years of age or younger
- Diagnosed with blindness
- 65 years of age or older
Income and resources requirements for Medicaid eligibility in NY
Depending on your various factors, like the size of your household, your medical needs, and your age, there are specific income and asset limits to be eligible for Medicaid in NY.
See below for tables that outline income limits (and assets) based on different criteria.
Please note that these are the limits during the time of writing (2020). Please be sure to check the New York State Medicaid page for the most current income limits.
Income before taxes for single individuals and couples without children
Net income limits for blind, disabled, and 65+ individuals
Resource limits for blind, disabled, and 65+ individuals
Medicaid eligibility can be more complex depending on various factors like your age, medical conditions, and other factors.
To check if you’re eligible based on your specific situation, you can visit Benefits.gov and complete their Medicaid eligibility quiz.
We will also include the contact information of NY Medicaid offices below. You can get in touch with them directly with any questions as well.
Can you apply for Medicaid in NY if you are above the income limit?
You could become eligible for Medicaid even if you earn more than the income limit, or if your assets are greater than the resource level requirements.
You can gain eligibility through the excess income program, asset spend downs, and exempt assets.
Excess income program
In some cases, depending on factors like why you need Medicaid (for example, pregnancy vs. disability), part of your income may not count towards the Medicaid income limit.
If you do qualify, generally speaking, any medical or wellness related bills will count as deductions towards your excess income. It could bring your countable income down enough to the point where you qualify for Medicaid.
If your assets exceed the eligibility requirements, then one of the factors that could still help you qualify is exempt assets.
When it comes to Medicaid qualification, there are two kinds of assets – countable and exempt.
Exempt assets are resources that you may own, but they are ones that do not count towards your asset limit for qualification.
Here are a few examples of exempt assets for Medicaid.
- Certain life insurance policies
- One vehicle
- Prepaid funeral or burial expenses
- Your home of residence
For a full list of countable and exempt assets, you can contact your county Medicaid office and ask for more details.
Asset spend down
Another way to qualify for Medicaid is to spend down your countable assets till you reach the eligibility requirements.
There are specific ways to spend your countable assets (cash, for example) that would reduce your overall assets and help you qualify for Medicaid.
Before you spend any of your assets to qualify, be sure to consult with your financial advisor for a plan that best suits your needs and goals.
Here are some examples of ways you can spend your countable assets.
- Prepay funeral expenses
- Pay off debt or purchase an annuity
- Make repairs/improvements to your home of residence
- Repair or purchase a vehicle
To learn more about how to reduce your countable assets, as well as more information about exempt assets and excess income, be sure to check out our in-depth guide on Medicaid spend down.
What benefits does Medicaid provide in NY?
If you’re eligible, Medicaid offers a full range of health services including the following:
- Doctors visits
- Medical supplies
- Lab tests
- Regular check-ups and follow up care
- Medical equipment
- Emergency care
- Nursing home care
- Hospital stays
- Dental care
For a full list of benefits, check out the New York Medicaid page.
CDPAP and Medicaid
If you’re eligible for Medicaid, and you’re living with a disability, Medicaid benefits in NY also includes Consumer Directed Personal Assistance Program (CDPAP).
CDPAP is a New York State Medicaid initiative that allows you to hire friends and family members (with some exceptions) as caregivers.
Your caregiver assists with various activities of daily living like grooming, hygiene, meal preparation, doctor’s visits, administering medicines, and more. They get paid through NY Medicaid for their services.
One of the most significant benefits of CDPAP is that you can continue living in your home and stay connected with your community, instead of having to live in a long term care facility like a nursing home.
And since you get to choose your caregiver, you get care from someone you’re comfortable with.
For more information on CDPAP, including eligibility criteria and how to apply, visit our CDPAP page.
What proofs will you have to bring to apply for Medicaid?
The evidence you need will vary depending on your age, medical conditions, and a few other factors.
These are some general requirements to give you an idea of what is needed.
Your case worker will let you know if there are any specific requirements for your application. Contact your local Medicaid office for more details.
Here is a list of the documents that you will need when applying for Medicaid in NY.
- Identity (driver’s license, passport, etc.)
- Proof of age
- Proof of citizenship or alien status
Proof of residence
- Mortgage statement
- Rent receipt
- A letter from your landlord
- Recent mail (bank statement, utility bill, etc.)
Proof of income
When it comes to income, you only need to show the ones that apply to you.
- Recent pay stubs (if working)
- Social security income (if any)
- Supplemental Security Income (if any)
- Unemployment benefits (if any)
- Child support payments (if any)
If you or someone in your household is diagnosed blind, disabled, or 65 years or older, then you need to show evidence of resources.
You can provide information on bank accounts, insurance policies, any homes you own, and documentation of any other resources.
Other medical insurance
If you currently have any other medical insurance, you need to provide that information as well. You can show your insurance card, policy information, or if you have Medicare, then your red, white, and blue card.
Medicaid Application Instructions
Here’s how to apply for Medicaid in NY.
Apply by phone
If you fall under the following category:
- 65 or older, and your age is a condition of eligibility, and you’re not a caretaking parent or relative
- You’re certified blind
- You have a disability and need long-term care, including CDPAP or other community based long term care (CBLTC)
Then you need to apply through a Local Department of Social Services (LDSS). You can find the phone number and other contact information for your LDSS here.
If you fall under these categories:
- You’re between 19-64 and not eligible for Medicare (not pregnant)
- Pregnant women and infants in need of care
- Children in need of care between the ages 1 – 18
- You’re the parent or the caretaker relative
Then you need to apply through the NY State of Health, The Official Health Plan Marketplace. Their phone number is (855) 355-5777.
Apply in person
If you want to apply in person, there are Medicaid offices in NY with Certified Application Counselors (CACs) to help you through the process and gain coverage.
For a list of the best offices in New York, check out our guide on NYC Medicaid offices.
Apply by mail
Similar to applying by phone, you need to check whether you need to apply through a Local Department of Social Services (LDSS), or through the NY State Health.
If you’re applying through an LDSS, then check your local office address, and mail your application there.
You can apply for Medicaid on the apply online at the New York State of Health website
Apply through a facilitated enroller (FE)
In NYC, you can get free in-person assistance to apply for Medicaid through a facilitated enroller (FE). You can qualify for an FE if you’re
- 65 years of age or older
- You have a disability
- You’re visually impaired
Check out the NYC Health page for information about offices in your burrough.
Helpful NY Medicaid resources
Applying for Medicaid can be a complex process depending on your medical conditions, resources, income, age, and more.
The good news is that there are plenty of helpful resources available to answer any questions you may have, and to provide you guidance.
Here are some helpful links.
NYC Human Resources Administration – They can help with the application process. You can call them at (718) 557-1399.
NY Medicaid Home – Check out the NY Medicaid home for further instructions and answers to FAQs.
Also, be sure to check out our guide on the best Medicaid plans in NY.