- Enrollment Assistors offer free personalized help.
- To speak with the Marketplace Customer Service Center call (855) 355-5777 (TTY: 1-800-662-1220)
Where you apply for Medicaid will depend on your category of eligibility. Certain applicants may apply through NY State of Health while others may need to apply through their Local Department of Social Service (LDSS). No matter where you start, representatives will help make sure you are able to apply in the correct location. For more information on determining your category of eligibility and where you should apply read on.
NY State of Health determines eligibility using Modified Adjusted Gross Income (MAGI) Rules. In general, income is counted with the same rules as the Internal Revenue Service (IRS) with minor variations. Individuals who are part of the MAGI eligibility groups listed below should apply with NY State of Health .
- Adults 19-64 years of age who are not eligible for Medicare,
- Children 1 - 18 years of age
- Infants (under age 1),
- Pregnant Individuals,
- Parents and Caretaker Relatives of any age, who may have Medicare.
Individuals who are part of the non-MAGI eligibility groups listed below should apply with their Local Department of Social Services (LDSS) or a Facilitated Enroller for the Aged, Blind and Disabled .
- Individuals 65 years of age and older, who are not a parent or caretaker relative,
- Individuals who are blind or disabled who do not meet the criteria of any of the above MAGI eligibility groups, including those individuals with an immediate need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS),
- Residents of Adult Homes run by LDSS, OMH, Residential Care Centers/Community Residences,
- Individuals eligible for the following programs:
- Medicare Savings Program (MSP)
- COBRA
- AIDS Health Insurance Program (AHIP)
- Medicaid Buy-in Program for Working People with Disabilities
Other factors that may affect your eligibility include:
- State Residency
- Citizenship or Immigration Status
- Family or Household size
- Income
Please Note: Applicants will be notified if proof of any of the above factors will be required to complete the processing of their application.
Medicaid Application for Non-MAGI Eligibility Group (DOH-4220)
This application (DOH-4220) should only be printed and completed if you are applying for Medicaid with your Local Department of Social Service (LDSS) and meet any of the criteria listed above for the "non-MAGI" eligibility group, or you are applying for Medicaid with a spenddown.
Supplement A (DOH-5178A)
This form (DOH-5178A) is a supplement to the Non-MAGI Medicaid Application (DOH-4220) above and completion is required for many applicants.
Of special interest to persons with disabilities:
If you think that you are disabled, but you do not have a certification of disability (e.g. from the Social Security Administration), you may be eligible for Medicaid even if your income is otherwise too high. You should apply at the Local Department of Social Services (LDSS). When you do, a referral will be made to the State Disability Review Unit (SDRU), where your medical information will be gathered in order to determine if you are certified disabled using the Social Security Administration's disability criteria. It may be necessary for you to have further examinations and/or tests for the disability to be determined. The cost of such examinations, consultations, and tests requested by the disability review unit, if not otherwise covered, will be covered by the LDSS or the State Disability Review Unit.
Please Note: Persons who are denied for reasons of failure to meet the disability criteria are entitled to appeal the disability decision that led to the denial of their application. The decision notice will contain information about appeal rights. See also the section of this page entitled "What are my rights?". Any person dissatisfied with the appeal decision of the New York State Office of Temporary and Disability Assistance may also appeal to the court system.
You may be required to apply for Medicare as a condition of eligibility for Medicaid.
Please review the following information on who is required to apply for Medicare and how to apply: OHIP-0112.
If you are blind or visually impaired many of DOH's forms are available in an alternative format. You may also submit form DOH-5130 (Alternative Format Supplement) to request information in an alternate format if you are blind or visually impaired.
Need help applying for MEDICARE?
If you have Medicaid and need help apply for MEDICARE the New York State Department of Health has contracted with several agencies that can help you. Contact one of our Facilitated Enrollers who can help you apply for MEDICARE. Facilitated Enrollers provide free, in person help in your community. To find a Facilitated Enroller near you, please see the list below of agencies, their contact phone number and the counties they serve.
Frequently Asked Questions
Eligibility
Learn about eligibility criteria for Medicaid, including income levels and what documents are required to apply.
Q. How do I know if I qualify for Medicaid?
If you qualify under a MAGI eligibility group, you will have to provide documents
to verify eligibility if necessary.- If you are applying for Medicaid through the Marketplace (NY State of Health), you may attest to your household income for the upcoming year. If your income is different than the income found on the data matches, income documentation may need to be provided.
- Citizenship/Immigration status and social security number will be verified through federal data sources. If citizenship/immigration status or social security number does not match, documentation must be provided.
If you qualify under a non-MAGI eligibility group, the following is a guide to the
documentation that must be submitted to help determine eligibility- If you are a U.S. citizen (born in the U.S. or one of its territories) and provide a valid Social Security Number (SSN), a match with the Social Security Administration (SSA) will verify your SSN, date of birth and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need to submit proof of naturalization (e.g., Naturalization Certificate (N-550 or N-570) or a U.S. passport.
- Proof of citizenship or immigration status*
- Proof of age (if not verified by SSA), like a birth certificate
- Four weeks of recent paycheck stubs (if you are working)
- Proof of your income from sources like Social Security, Veteran's Benefits (VA), retirement benefits, Unemployment Insurance Benefits (UIB), Child Support payments
- If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information on bank accounts, insurance policies and other resources
- Proof of where you live, such as a rent receipt, landlord statement, mortgage statement, or envelope from mail you received recently
- Insurance benefit card or the policy (if you have any other health insurance)
- Medicare Benefit Card (the red, white, and blue card)**
- *Note: Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition and you meet all other Medicaid eligibility requirements.
- **Note: As a condition of eligibility for Medicaid, if you appear eligible for Medicare, you must apply and show proof of application.
You are required to apply for Medicare if:- You have Chronic Renal Failure or Amyotrophic Lateral Sclerosis (ALS); OR
- You are turning age 65 in the next three months or are already age 65 or older; AND your income is below 120% of the Federal Poverty Level (based on the household size for a single individual or married couple), or is at or below the applicable Medicaid Standard, then the Medicaid program will pay or reimburse you the cost of your Medicare premiums. If the Medicaid program can pay your premiums, you will be required to apply for Medicare as a condition of Medicaid eligibility.
- Your award or denial letter from the Social Security Administration, OR
- Your on-line confirmation letter stating that you have applied for Medicare with the Social Security Administration.
- https://www.ssa.gov/medicare/
- https://www.medicare.gov/people-like-me/new-to-medicare/getting-started-with-medicare.html
- Social Security Administration 1-800-772-1213
Q. If I think I am eligible for Medicaid, should I cancel any other health insurance I might already have?
A. No. If you currently pay for health insurance or Medicare coverage or have the option of getting that coverage, but cannot afford the payment, Medicaid can pay the premiums under certain circumstances.
Even if you are not eligible for Medicaid benefits, the premiums can still be paid, in some instances, if you lose your job or have your work hours reduced. If you need help with a COBRA premium, you must apply quickly, to determine if Medicaid can help pay the premium.
You may be eligible for the Medicare Savings Program. This program pays your Medicare premiums and for some consumers, can also pay your Medicare deductibles, coinsurance, and copayments.
If you have Acquired Immune Deficiency Syndrome (AIDS), Medicaid may be able to help pay your health insurance premiums.
Q. How do I know if my income and resources qualify me for Medicaid?
A. The chart below shows how much income you can receive in a month and the amount of resources (if applicable) you can retain and still qualify for Medicaid. The income and resource (if applicable) levels depend on the number of your family members who live with you.
Family Size Net Income for Families and Individuals who are Blind, Disabled or Age 65+ Resource Level
(Individuals who are Blind,
Disabled or Age 65+ ONLY)Annual Monthly 1 $20,783 $1,732 $31,175 2 $28,208 $2,351 $42,312 3 $35,632 $2,970 4 $43,056 $3,588 5 $50,481 $4,207 6 $57,905 $4,826 7 $65,330 $5,445 8 $72,754 $6,063 9 $80,178 $6,682 10 $87,603 $7,301 For each additional person, add: $7,425 $619 Effective January 1, 2024. Income and Resource Levels are subject to yearly adjustments.
You may also own a home, a car, and personal property and still be eligible. The income and resources (if applicable) of legally responsible relatives in the household will also be counted.
Expanded Income levels for Children and Pregnant Individuals
- Infants to age one and pregnant individuals - 223% of the federal poverty level.
- Children age 1 through 18 years - 154% of the federal poverty level.
Monthly Income Effective January 1, 2022 * Number in Family 154% FPL** 223% FPL** 1 $1,745 $2,526 2 $2,350 $3,403 3 $2,956 $4,280 4 $3,562 $5,157 5 $4,167 $6,035 6 $4,773 $6,912 7 $5,379 $7,789 8 $5,985 $8,666 For each additional person, add: $606 $878 - * Income Levels are subject to yearly adjustments.
- ** FPL = Federal Poverty Level
If a child has too much income and is not eligible for Medicaid, the child may be eligible for Child Health Plus.
Q. If my income is in a Trust, does that impact my Medicaid eligibility?
A. For more information on Trusts, please visit our Trust-Specific information page.
Q. Can I be eligible for Medicaid even if I make more money than the chart shows?
A. Yes, some people can. If you are under 21 years of age, over 65 years of age, certified blind, certified disabled, pregnant, or a parent of a child under 21 years of age, you may be eligible for Medicaid if your income is above these levels and have medical bills. For more information please visit the Medicaid Excess Income Program webpage.
People who are certified blind, certified disabled, or age 65 or older who have more resources may also be eligible.
If an adult has too much income and/or resources and is not eligible for Medicaid, they may be eligible for the Family Planning Benefit Program.
Q. Will there be a lien (legal claim) placed on my estate (my assets) when I die?
If you receive medical services paid for by Medicaid on or after your 55th birthday, or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.
For individuals who received Medicaid under a MAGI eligibility group, the estate recovery is limited to the amount Medicaid paid for the cost of nursing facility services, home and community-based services, and related hospital and prescription drug services received on or after the individual's 55th birthday.
How Do I Request an Assessment of My and My Spouse's Resources for Spousal Impoverishment?
Either spouse, or a representative acting on their behalf, may request an assessment of the couple's countable resources at the beginning or any time after the beginning of a continuous period of institutionalization. The DOH-5298, "Request for Assessment– Spousal Impoverishment" form is used to request an assessment. Upon receipt of such request and all relevant documentation, the local district will assess the total value of the couple's countable resources and provide each spouse with a copy of the assessment and the documentation upon which it is based. If the request is not filed with a NYS Medicaid application, the local department of social services may charge up to $25.00 for the cost of preparing and copying the assessment and documentation.
If you wish to request an assessment of the total value of your and your spouse's countable resources, a determination of the community spouse resource allowance, community spouse monthly income allowance, or family member allowance(s) and the method of computing such allowances, please contact your local department of social services. NYC residents should call the HRA Medicaid Helpline at (888) 692-6116.
Children and Pregnant Individuals
Learn about Medicaid eligibility for children and pregnant individuals.
Q. What are the Medicaid eligible income levels for children and pregnant individuals?
- Infants to up to one year of age and pregnant individuals = 223% of the federal poverty level. Children one year of age through 18 years of age = 154% of the federal poverty level.
Monthly Income Effective January 1, 2022 * Number in Family 154% FPL** 223% FPL** 1 $1,745 $2,526 2 $2,350 $3,403 3 $2,956 $4,280 4 $3,562 $5,157 5 $4,167 $6,035 6 $4,773 $6,912 7 $5,379 $7,789 8 $5,985 $8,666 For each additional person, add: $606 $878 - * Income Levels are subject to yearly adjustments.
- ** FPL = Federal Poverty Level
Q. Where do I find more information about Child Health Plus.
A.Additional information on Child Health Plus, including how to apply, can be found at: www.health.ny.gov/health_care/child_health_plus/.
Applicants who are Blind, Disabled, and/or Over 65 Years of Age
Learn about specific circumstances for certain categories of applicants.
Q. What are resources?
A.Resources are cash or those assets, which can be readily converted to cash, such as bank accounts, life insurance policies, stocks, bonds, mutual fund shares and promissory notes. Resources also include property not readily converted to cash (i.e., real property)
Q. Can I still keep part of my income if I am in a Residential Health Care Facility or in an intermediate care facility for the developmentally disabled?
A.Yes. Under Medicaid you are allowed to keep a small amount for your personal needs. You can also keep some of your income for your family if they are dependent on you. A spouse who remains in the community may also keep resources and income above the levels shown.
Q. What is a "lookback" period?
- Spouse
- Child under the age of 21
- Sibling who has an equity interest in the home and has resided in the home for at least one year immediately prior to you entering the Nursing Home.
- Adult child who resided in the home for at least two years, immediately prior to you entering the Nursing Home and who provided care to you which permitted you to reside at home rather than in a medical facility.
Q. What is a Life Estate? Will it make me ineligible?
A. A life estate is limited interest in real property. A life estate holder does not have full title to the property, but has the use of the property for his or her lifetime, or for a specified period. The life estate is not considered a countable resource, and no lien may be placed on it.
If you or your spouse sell the life estate interest for less than fair market value, it can be considered a transfer of assets and may be subject to the penalty period.
Q. Am I allowed to have a pre-paid burial fund?
A. You may establish an irrevocable pre-need funeral agreement with a funeral firm, funeral director, undertaker or any other person, firm or corporation which can create such an agreement for your funeral and burial expenses. Pre-need burial agreements purchased for certain members of your family on or after January 1, 2011 must also be irrevocable. The pre-need funeral agreement is used towards burial and funeral expenses and is not counted as a resource when determining Medicaid eligibility.
If you (your spouse) do not have an irrevocable pre-need funeral agreement or if the irrevocable pre-need agreement has less than $1500 designated for non-burial space items, you may be allowed to have money set aside in a burial fund. The limit for single individuals is $1500 or $3000 for a couple. Please note, these funds, must be kept separate from any non- burial fund related resources.
Q. If I have an immediate need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS), can I get my eligibility for these services processed more quickly?
- have no voluntary informal caregivers able and willing to provide or continue to provide care;
- are not receiving needed assistance from a home care services agency;
- have no third party insurance or Medicare benefits available to pay for needed assistance; and
- have no adaptive or specialized equipment or supplies in use to meet, or that cannot meet, your need for assistance.
Application Process and Fair Hearings
Learn about what happens when you apply for Medicaid and how you can request a "fair hearing" if needed.
Q. How long does it take to get Medicaid?
A. Generally, a determination of eligibility must be done and a letter sent notifying you if your application has been accepted or denied within 45 days of the date of your application. If you are pregnant or applying on behalf of children, a determination should be made within 30 days from the date of your application. If you are applying and have a disability which must be evaluated, it can take up to 90 days to determine if you are eligible.
Q. How do I designate or change an authorized representative?
A.When you complete the Access NY Health Care application (DOH-4220) or apply through NY State of Health you may assign a representative. You may allow this representative to apply for and/or renew Medicaid for you, discuss your Medicaid application or case, and/or allow them to get notices and correspondence. You can authorize or change a representative at renewal or anytime in between renewals.
If you recieve Medicaid through your local department of social service (LDSS), you may fill out form DOH-5247 and submit this with your renewal.
If you recieve Medicaid through NY State of Health, you may fill out form DOH-5085 and submit to NY State of Health.
Q. What are my personal privacy rights?
A. Personal privacy rights apply to all Medicaid applications and participants. The New York State Personal Privacy Protection Law and the federal Privacy Act require the New York State Department of Health to tell you what it does with the information, including Social Security Numbers (SSN) that you give the State or sometimes, to your LDSS, about you and your family. The Privacy Act statement is on your application form.
How do I request a fair hearing?
- Telephone: (800) 342-3334Please have the notice, if any, available when you call.
- Fax: (518) 473-6735
- Online: Complete and submit the Online Request Form
- In Writing: On the notice, complete the space proveded and send a copy of the notice, or write to: NYS Office of Temporary and Disability Assistance Office of Administrative Hearings P.O. Box 1930 Albany, New York 12201-1930
- Telephone: (855) 355-5777
- Fax: (855) 900-5557
- Online:www.nystateofhealth.ny.gov
- In Writing: New York State of Health P.O. Box 11729 Albany, New York 12211
Additional Programs and Resources
Learn where to find information on additional NY Medicaid administered programs.
Application and eligibility requirements may vary for each program. Please see the individual program web pages for specific information and criteria.
- Traumatic Brain Injury (TBI)
- Consumer Directed Personal Assistance Services (CDPAS)
- Medicaid Buy-in Program for Working People with Disabilities
- Family Planning Benefit Program
- Medicare Savings Program
- Care at Home: A Handbook for Parents
- Medicaid Excess Income Program
