Medicaid In New York State
- COVID-19 News and Updates:
- COVID Information for Medicaid Consumers:
- Medicaid Coverage through Your Local Department of Social Services during the Coronavirus Emergency –
- Medicaid Telehealth Services During the Coronavirus Emergency –
- IRS Form 1095-B Update:
- The 1095-B form for Tax Year 2020 is no longer being mailed automatically.If you need a copy of your 1095-B for Tax Year 2020, you can request it:
- By e-mail – or
Governor Pushed Back Against Gop Efforts To Repeal The Aca
In January 2017, as President Trump was poised to take office and it was clear that GOP lawmakers were going to push hard for ACA repeal, New Yorks then-Governor Andrew Cuomo announced that 2.7 million people were at risk of losing Medicaid coverage in New York if the ACA was repealed and not replaced with something equally robust, and that the state budget impact would be $3.7 billion.
Although most of the New Yorks Medicaid enrollees were already eligible under the states pre-2014 guidelines, the state estimated that several million Medicaid enrollees would have lost coverage if the ACA had been repealed. Thats because the state was using 1115 waivers to expand coverage eligibility in the years prior to ACA implementation, and the federal government was splitting the cost with the state as called for in the waivers.
But those waivers expired after Medicaid expansion was implemented. If the ACAs Medicaid expansion had been repealed, eligibility would have reverted to much lower thresholds: parents with dependent children would have been covered with income up to 94% of the poverty level , and childless adults wouldnt have been eligible at all. The state would have been allowed to spend their own money to extend those guidelines, but it would have been fiscally challenging without the federal match.
Ultimately, the ACA survived the legislative onslaught in 2017 and a Supreme Court case that upheld the law in 2021.
Medicaid expansion in New York
What Does The Essential Plan Cost
Starting in 2021 all Essential plans have removed their monthly premium requirements and are now free! There are a total of 4 Essential plan options, each based on your current income. There are no family plans with the essential plan, only individual coverage. Children are not eligible for the Essential Plan, however, if the parent qualify for the Essential then the children are most likely eligible for Child Health Plus
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Learn About The Financial Requirements To Get Medicaid In New York State
When a client asks me if they can qualify for Medicaid in New York, I ask about their assets, income, living situation, and health. Some clients they may be able to qualify rather easily. Others may need to engage in some planning in order to qualify for Medicaid. Yet others automatically assume that they can not qualify for Medicaid and unnecessarily spend much of their own money on their medical care.
This article explains the requirements necessary for qualifying for Medicaid and offers some basic Medicaid planning options. Subsequent articles will deal with Medicaid planning options in more detail.
How Do I Get A New Medicaid Card In Ny
Getting a new Medicaid card in New York if your card has been stolen, lost, or damaged is a relatively simple process. The process for getting a card replaced is one that can be done online or over the phone. You will have to go through the process of getting a new Medicaid card when an old one expires, or you may also need a replacement if you lose your card, if it gets damaged, or if it is stolen.
One way to get a new Medicaid card in New York is to call the New York State Department of Healthâs Medicaid Help Hotline at 1-800-541-2831. You may also call the number located on the back of your Medicaid card . Once on the phone call, you may speak to either a representative or you will be directed to an automated answering machine where you can go answer the requisite questions in order to obtain a new Medicaid card. You will need to provide your Medicaid ID number, social security number, birth date, and current address. If you are unable to provide your Medicaid ID number, you will not be able to use an automated system to renew your card and youâll have to speak to a representative first.
If you donât have your Medicaid ID number on file, simply ask the representative to help you get this information. They will need identifying information such as your social security number and birthdate to find your Medicaid ID.
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What Are The Income Requirements For Medicaid
Medicaid income requirements are based on resource levels in the state. Income requirements for Medicaid differ for those whole are blind, disabled or above age 65, in comparison to single individuals and couples without children. In addition, your assets are taken into account. When it comes to bypassing the financial Medicaid requirements, you can only report more money than the state allows if you are a child, disabled or blind, above 65 or pregnant.
to learn all about the different requirements for Medicaid.
Some patients who want to be accepted for Medicaid benefits eligibility in NY will already have a pre-existing condition or a disability. The Medicaid Buy-In Program was designed for people in New York with incomes higher than the standard threshold who are still in employment. Vital healthcare insurance coverage can be retained when a person learns how to qualify for Medicaid in this program.
In order to qualify into the Medicaid Buy-In Program, you must be a New York state resident, be at least 16 years old, have a gross income of $60,420 to $81,132, be employed on a part-time or full-time basis and have a Social Security Administration-defined disability.
Payments If You Lost Your Job Are Working Less Are Furloughed Or Cant Go To Work Because Of Covid
Unemployment Insurance and Pandemic Unemployment Assistance
Unemployment Insurance and Pandemic Unemployment Assistance give temporary income to workers who lose their jobs or have their hours significantly reduced. Youre likely eligible for benefits if you lost work because of COVID-19 and arent getting other paid leave, even if you dont usually qualify for UI.
Apply on the NY Department of Labor website, and the system will determine if you are eligible for UI or PUA.
Pandemic Unemployment Compensation
Pandemic Emergency Unemployment Compensation provides an extra $600 per week on top of usual weekly unemployment benefits. If youre eligible for UI or PUA, youll automatically receive the additional payment from PEUC.
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What Does Medicaid In New York Cover
Medicaid covers a wide range of healthcare related services, including the following for most participants:
- smoking cessation agents
- treatment and preventive health and dental care
- hospital inpatient and outpatient services
- laboratory and X-ray services
- care in a nursing home
- care through home health agencies and personal care
- treatment in psychiatric hospitals , mental health facilities, and facilities for the mentally retarded or the developmentally disabled
- family planning services
- early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
- medicine, supplies, medical equipment, and appliances
- clinic services
- transportation to medical appointments, including public transportation and car mileage
- emergency ambulance transportation to a hospital
- prenatal care
- some insurance and Medicare premiums
Medicaid Dental Coverage Ny
NYS Medicaid covers all essential dental services. Essential means that only medically necessary procedures will be covered, such as extractions to prevent disease. Kids can receive a bit more dental care thanks to the EPSDT program. That includes regular oral exams as well as preventative, restorative, and emergency dental care. Kids can also get emergency orthodontic care. Implants, bridgework, dentures, and cosmetic work are NOT included.
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Income And Resource Limits For New York State Public Health Insurance Programs
NYS updated the 2021 levels with GIS 21 MA/06 -with the 2021 Federal Poverty Levels
Disabled, 65+ or Blind and have Medicare
|MAGI *138% FPL***Children < 5 and pregnant women have HIGHER LIMITS than shown|
For MAGI-eligible people over MAGI income limit up to 200% FPL
No long term care.
|NO LIMIT**||NO LIMIT|
* MAGI and ESSENTIAL plan levels are based on Federal Poverty Levels, which are not released until later in 2021. 2020 levels are used until then.
NEED TO KNOW PAST MEDICAID INCOME AND RESOURCE LEVELS?
HOW TO READ THE HRA Medicaid Levels chart –
MAGI INCOME LEVEL of 138% FPL applies to most adults who are not disabled and who do not have Medicare, AND can also apply to adults with Medicare if they have a dependent child/relative under age 18 or under 19 if in school. 42 C.F.R. § 435.4.
Certain populations have an even higher income limit –
- 224% FPL for pregnant women and babies < age 1,
- 154% FPL for children age 1 – 19.
- See all income limits on MAPDR-01 HRA income limits chart.
Choosing The Right Essential Plan For You And Your Family
Most counties in New York State have more than one Essential Plan health insurance company for you to choose from. Since many insurance companies have contracts with different doctors and hospitals, it may be that your preferred doctor and hospital are not on every plan offered. When you shop for an Essential Plan check to ensure that your doctor and preferred hospital are part of the provider network.
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What Does A Medicaid Card Look Like
In the state of New York, Medicaid recipients receive a Common Benefit Identification Card that is currently blue and gray with a yellow stripe dividing the top of the card from the bottom. This card can be used by recipients of various New York government benefit programs including the Temporary Assistance to Needy Families , the Supplemental Nutrition Assistance Program , the Healthcare Exchange program, and Medicaid .
The CBIC card contains basic information including the following:
â Your name
â Your date of birth
â Your Medicaid ID number
â The card number
â The access number
â Your photo
â Your signature
This card should be presented at healthcare appointments.
Asset & Income Limits
First, the applicant must meet the necessary assets levels. In 2021, an individual applying for home care Medicaid may have up to $15,900.00 in non-exempt assets. Certain assets are exempt, and include an irrevocable pre-paid burial fund, life insurance with a cash surrender value not to exceed $1,500.00, and retirement accounts so long as the minimum distributions are being taken.
A primary residence is also an exempt resource for Community Medicaid eligibility if a spouse, minor child, or disabled child is living in the home or if single, the equity value in the home is less than $893,000. However, where the applicant owns a home it is advisable to consult an attorney to avoid any potential estate recovery after the Medicaid recipient passes away, which can result if the applicant enters a nursing home or if the spouse, minor or disabled child no longer live there.
Second, the applicant is permitted to keep $875.00 per month in income plus a $20.00 disregard. However, where the applicant has income which exceeds that $895.00 threshold, a Pooled Income Trust can be established to preserve the applicants excess income and direct it to a fund where it can be used to pay his or her household bills.
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How Does Medicaid Provide Financial Assistance To Medicare Beneficiaries In New York
Many Medicare beneficiaries receive Medicaid financial assistance that can pay for Medicare premiums, lower prescription drug costs, and cover expenses not reimbursed by Medicare such as long-term care.
Our guide to financial assistance for Medicare enrollees in New York includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
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.
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The Community Medicaid Program In New York State
The Community Based Medicaid program assists applicants in paying for the cost of nursing home level care while remaining in their home. The Medicaid home care program can also pay for certain adult day care programs and needed medical supplies. Since Medicaid is a mean-based joint state and federal program, certain eligibility requirements must be met in order to qualify.
Nys Medicaid Otc Formulary And Prescription Drug Coverage
The NYS Medicaid formulary is very comprehensive the PDF is 659 pages long! NYS Medicaid providers are expected to select the cheapest option of any drug they prescribe to a New York Medicaid beneficiary. In most cases, this means that the generic form of the drug will be selected. If you notice that your doctor prescribes a brand-name drug, ask and make sure that it is the most affordable option. NYS Medicaid may cover brand-name drugs as well, but generic options are almost always cheaper. Generic drugs usually provide the same benefits as their brand-name counterparts.
In some cases, New York Medicaid may provide reimbursements for over-the-counter products as well. To get that reimbursement, your doctor will need to provide a fiscal order, which is sort of like a prescription for over-the-counter drugs and products.
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Cost And Coverage Of Medicaid In New York
Estimates for the cost of Medicaid can vary depending on things like the individual patient and services needed. These copays will be small. People who will receive free healthcare from Medicaid include those who are under the age of 21, women who are pregnant, and patients who are in long-term care.
As far as coverage goes, Medicaid typically pays for most medical services, along with any medications and supplies that are needed. This includes coverage for things like:
- Family planning services and prenatal care
- Ambulance rides to the hospital in emergency situations
- Public transportation or car mileage to the patients medical appointments
- Medicines, supplies, medical equipment, and appliances
- Early screening, diagnosis, and treatment for beneficiaries who are under 21
- Other various services that might be needed
Includes An Immigrant Eligibility Crosswalk Which Gives Detailed Eligibility Information For Immigrants For Various Health Programs
Current NYS DOH policy defining the PRUCOL category can be found at:
- 21 INF-01 – Clarification of PRUCOL Status for the Purposes of Medicaid Eligibility
Immigrants should be classified as PRUCOL by the social services district if :
They can provide evidence that the USCIS or ICE knows that they are here and
The immigration agencies are not contemplating enforcing their departure. This is indicated either because:
because of the immigration agencys inaction, can be considered to be acquiescing in their continued presence.
These factors are described more below.
An official application filed with USCIS for adjustment of status to lawful permanent alien , for asylum, temporary protected status, or suspension of deportation. If an official written application was filed, and
Proof of mailing by certified receipt iOR a receipt from the immigration service is provided, this is enough.
The immigrant or his/her representative has made a request by letter to the immigration agency requesting a particular recognized type of relief, such as deferred action or voluntary departure, with proof of receipt by certified mail. These requests are usually based on humanitarian or medical grounds.
2. WHAT PROOF IS NEEDED THAT AN IMMIGRATION AGENCY IS NOT ENFORCING THEIR DEPARTURE?
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If I Cannot Keep Medicaid Do I Have Other Options For Health Insurance Coverage
Yes, you have many options for health insurance coverage in New York.
Child Health PlusChildren under the age of 19 who are not eligible for Medicaid and have no other health insurance may qualify for free or affordable health coverage through Child Health Plus depending on family income. Monthly premiums range from $0 to $60 depending on family income and household size. Child Health Plus covers doctor visits including wellchild visits, inpatient and outpatient hospital care, prescription drugs, preventive and routine vision care, speech and hearing services, and more. You can enroll through the New York State of Health online or over the phone at 855-355-5777.
Essential PlanThe Essential Plan is a health insurance program for New Yorkers who do not qualify for Medicaid or Child Health Plus but who cannot afford full premium coverage. Monthly premiums range from $0 to $46 per month based on your income. The Essential Plan covers doctor visits including specialists, tests ordered by your doctor, prescription drugs, inpatient and outpatient care at a hospital, and more. You can enroll through the New York State of Health online or over the phone at 855-355-5777.
How To Apply For Medicaid In Ny
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 arenât 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.