How To Apply For New York State Medicaid

Are Medicaid And Medicare The Same Thing

No. Medicaid is a needs-based program primarily used to pay for long-term care, whether in a nursing home or through New York’s Home and Community-Based Services program.

Medicare is a government-sponsored healthcare insurance program that covers adults over 65 and people with severe disabilities. While it covers regular doctors’ visits, emergency treatment, and prescriptions, it won’t provide enough to cover the full costs of long-term nursing care.

How To Apply For Ny Medicaid

You may apply for Medicaid in the following ways:

• Enrollment Assistors offer free personalized help.
• To speak with the Marketplace Customer Service Center call 355-5777
• Through a Managed Care Organization
• Call the Medicaid Helpline 541-2831
• Through your Local Department of Social Services Office

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 . 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 Rules. In general, income is counted with the same rules as the Internal Revenue Service 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 and not eligible for Medicare,
• Children 1 – 18 years of age
• Pregnant Individuals,
• Parents and Caretaker Relatives of any age

Individuals who are part of the non-MAGI eligibility groups listed below should apply with their Local Department of Social Services .

Other factors that may affect your eligibility include:

• State Residency
• Family or Household size

Medicaid Application for Non-MAGI Eligibility Group

Supplement A

Until When Will Medicaid Estate Recovery In New York Be Deferred

Medicaid estate recovery will be deferred only until:

• The death of the dependent, heir, or survivor or
• The sale, refinance, transfer or change in title of the real property or
• The determination by the Medicaid program that the dependent, heir, or survivor is in breach of the repayment agreement.

So to answer the title question, is Medicaid truly free? the answer is no, not at all. Knowing why and how Medicaid estate recovery can affect your properties and possibly the lives of your survivors could help you mitigate future inconvenience that you may leave behind. Talk to us to see how we can help you.

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Eligibility Criteria For Ny Medicaids Long Term Care Programs

To be eligible for NY Medicaid, a person has to meet certain financial requirements and functional requirements. The financial requirements vary by the applicants marital status, if their spouse is also applying for Medicaid and what program they are applying for Nursing Home Medicaid, Home and Community Based Service Waivers or Disabled, Aged 65+ or Blind / Regular Medicaid.

NY Medicaid Nursing Home Medicaid Eligibility Criteria

For married applicants with both spouses applying, the 2022 asset limit for Nursing Home Medicaid through NY Medicaid is $24,600 combined between the two applicants/spouses and the income limit is $1,367 / month combined. For a married applicant with just one spouse applying, the 2022 asset limit is $16,800 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $934 / month for the applicant. The income of the non-applicant spouse is not counted. However, if the income of the non-applicant spouse is greater than $3,435 / month, NY Medicaid will request that 25% of the amount over $3,435 / month be given to the state to help cover the care costs of the applicant spouse. If the non-applicant spouse does not want to do this, they can institute spousal refusal.

NY Medicaid Home and Community Based Services Waivers Eligibility Criteria

NY Medicaid Disabled, Aged 65+ or Blind Medicaid Eligibility Criteria

New York Medicaid Application

As of June 2015, the average monthly enrollment in the New York Medicaid program reached 6,441,902. The state of New York chose to make its own health benefits exchange situated at the NY State of Health website. Before the execution of the Affordable Care Act, New York was ahead of the medical insurance market concerning coverage for residents.

The health benefits market was created in 2012 by Governor Andrew Cuomo. Prior to the beginning of the state-funded market, the country ran Family Health Plus. This strategy was aimed toward providing health insurance coverage for low income adults residing in the state of New York. The state has expanded its Medicaid program since its beginning, covering hundreds of thousands more New Yorkers as a result.

Whats Covered Under Medicaid

Whos Covered Under Medicaid

• Adults who receive incomes of around 138 percent of the federal poverty level are eligible to receive Medicaid coverage.
• Pregnant women and babies whose household income doesnt exceed 218 percentage of the federal poverty level are eligible for coverage under the program.
• For kids in New York, CHIP is another program which allows participation for children whose family income doesnt exceed 400 percent of the federal poverty level.

After the Medicaid Application

Eligible parties will be given a letter telling them of the acceptance or rejection for New York Medicaid coverage.

Hearings on the Application Procedure

PO Box 1930

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Appealing A Denial Of Medicaid

Tip: Save the envelope as well as the letter. You may need it to prove when you received the letter.

How To Apply If In Ny City:

If you are in New York City, you can easily obtain applications from Human Resources Administration. You can also request information and applications on phone by calling at 718 557 1399.

NOTE: If you need any further assistance, you can call helpline at 693-6765.

Other requirements for applying

In order to apply for Medicaid, you will need to provide

• Proof of citizenship
• If someone above 65 years of age, disabled or blind lives with you, you will need to provide proof of your income and resources
• Proof of your residence
• If you have any other insurance, you’ll be required to provide its proof and information about it

Medicaid Benefits

Medicaid provides a comprehensive coverage for various health services including

• Inpatient and outpatient services
• Home health care through approved agencies
• Access to smoking cessation agents
• Lab facilities and access to tests
• Eye, dental and mental health services
• Prescription drugs, medical supplies, and necessary medical equipment
• Transportation services

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Early Planning Is Key To Getting Medicaid When You Need It

At Landskind & Ricaforte Law Group, P.C., we know the difference Medicaid benefits can make to people who need care as soon as possible. We guide you through all steps of the process, getting you the care you need without sacrificing your loved ones’ inheritances. Call us today at 333-5007 or contact us through our online form to learn how we can be of assistance.

New York State Medicaid

• Important Renewal Changes

New York’s Medicaid program provides comprehensive health coverage to more than 7.3 million lower-income New Yorkers Medicaid pays for a wide-range of services, depending on your age, financial circumstances, family situation, or living arrangements. These services are provided through a large network of health care providers that you can access directly using your Medicaid card or through your managed care plan if you are enrolled in managed care. Some services may have small co-payments, which can be waived if you cannot afford them.

Use the link below to see which health insurance options are available to you, including if your income qualifies you for NYS Medicaid.

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Are You A Person With A Disability Who Is Working

The Medicaid Buy-In program offers coverage to people with disabilities who are working and earning more than what is allowed in traditional Medicaid.

To qualify you must meet all the following requirements:

• Be a resident of New York City
• Be between 16-64 years of age
• Have a disability as defined by the Social Security Administration or by New York State
• Have resources not exceeding $20,000 for an individual and $30,000 for a couple
• Have an income below 250% of the federal poverty level . However, the way income is calculated allows you to earn more than the FPL and still be eligible. For example, in 2021, 250% of the FPL was around $32,208, but people with $65,436 in earned income could still be eligible. You can use the Income Test Worksheet on page 6 of the toolkit for the MBI-WPD program to get a better sense of whether you might be eligible at your income level.

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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Option 3 Download Application

The Department of Health Care Services and Covered California have partnered to create a Single Streamlined Application for affordable health care coverage.

You can use the Single Streamlined Application to apply for a range of affordable health care coverage options, including free or low cost Medi-Cal.

First, , complete it, You can mail your completed and signed application to:

Covered California

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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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New York Medicaid Long Term Care Programs Benefits & Eligibility Requirements

SummaryMedicaid is a joint federal and state program, so its rules, coverage plans and even its name all vary by state. In New York, Medicaid is referred to as NY Medicaid, NYS Medicaid, Medicaid Managed Care, or simply, Medicaid. This article focuses on NY Medicaid Long Term Care, which is different from regular Medicaid. Medicaid will help pay for long term care for New York residents in a nursing home, in their home and in other residential settings including assisted living through one of three programs Nursing Home / Institutional Medicaid, Home and Community Based Service / Medicaid Waivers and Disabled, Aged 65+ or Blind Medicaid.

Are You Already Getting Insurance Through Your Employer

If you have health insurance coverage through your employer, you should keep that insurance and reach out to HRA. Medicaid may cover the cost of the premium for that insurance coverage.

The MBI-WPD program does not offer family coverage. Single people and married couples are both covered under this program if both individuals are working and have a disability. Spouses without a disability and children may be covered through other programs such as Medicaid through New York State of Health or Child Health Plus.

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Where Can I Go To Apply For Medicaid

Here is a list of resources for you or your loved one to begin applying for Medicaid if you reside in the state of New York.

• Apply By Phone Contact the New York State Department of Health to get the phone number for your location
• Apply Online Download the Medicaid application via the New York State Department of Health Marketplace website
• Apply By Mail Download the Medicaid application via the Health Marketplace website and mail it in
• Apply In-Person Visit your local Social Services office and follow their instructions on how to apply in-person
• Facilitated Enroller A Facilitated Enroller can assist you with the application process. Obtain a list of FEs here.
• New York City Residents If you live in New York City, you can apply here.

About the author, Carlos Nath:

Carlos Nath is the Senior Trust Advisor with KTS Pooled Trust. As a seasoned professional with over four years of experience in the New York pooled trust space, Carlos has helped thousands to enroll and set up their accounts with KTS. He is proficient in understanding the Medicare process and provides assistance in clarifying what clients may need. Previously, Carlos worked with a Medicaid consulting firm as an advisor who helped clients who were seeking Medicaid assistance.

Helping Individuals Determine Their Eligibility For Medicaid And Complete The Necessary Paperwork

In a nutshell, both federal and New York state law govern Medicaid. It helps senior citizens afford the high cost of long-term healthcaremost often in nursing homes, at home, or in assisted living facilities.

With all of the benefits of the New York Medicaid Program, the program can still be extremely difficult to navigate and often leaves many applicants with few answers and many more questions. This is due, in part, to the complex state and federal laws that govern the program, as well as the fact that these requirements are changing and evolving on a continuous basis. In cases where applicants make even a small financial mistake, they could receive a denial of coverage, or they could face other significant losses.

Fortunately, you do not need to handle the complex Medicaid application process on your own. The experienced New York senior law attorneys at Goldfarb Abrandt & Salzman LLP, are ready and willing to assist you throughout the process. Our knowledgeable legal team can sit down with you during an initial consultation and assist you in determining your eligibility.

Furthermore, our attorneys can be by your side during the entire process, from the initial application consultation up through your final approval. Given our many years of experience in the business, we can help you seamlessly navigate the process and avoid the common challenges and pitfalls.

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Overview Medicaid For Seniors In Ny

While Medicaid programs target different groups of people, this report is concerned only with long-term care that benefits the seniors and elderly, with a focus on the state of New York. Medicaid is a joint venture between the Federal government and each state, catering mostly to low-income people. The Federal government provides subsidies and sets basic standards while, generally speaking, each state sets eligibility requirements and other rules that govern services. Some 66 million people received Medicaid benefits in 2018, of those 7.2 million , making it the largest payer of healthcare benefits in the United States.

Here is a brief summary of the type of elderly-related programs that Medicaid offers in the state of New York:

• Nursing homes: If you are a senior or elderly Medicaid beneficiary, Medicaid has traditionally paid for long-term care in all Medicaid-certified nursing homes or senior living homes.

• Home-based programs:For at-home care, Medicaid has several programs in the state of New York for seniors and elderly that cover home health care as well as personal care .

Home and community-based programs: In 2018, every state in the country, as well as D.C., offered at least one program that pays for elderly-related services for those who choose not to become nursing home residents. The state of New York has various programs that provide assistance at home for seniors, in assisted living facilities , in day care, and with other home-related chores.