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. Please Note: Applicants will be notified if proof of any of the above factors will be required to complete the processing of their application. 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. This form (DOH-5178A) is a supplement to the Non-MAGI Medicaid Application (DOH-4220) above and completion is required for many applicants. 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. For answers to the most common eligibility and enrollment questions please review the Frequently Asked Questions and the Additional Resources tabs below. You can also call the Medicaid Helpline at (800) 541-2831 or submit questions via email to . How do I know if I qualify for Medicaid?You may qualify for Medicaid depending on your age, financial circumstances, family situation, or living arrangement. Use the link below to see which health insurance options are available to you, including if your income qualifies you for NYS Medicaid.
How do I designate or change an authorized representative?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. If I have an immediate need for Personal Care Services (PCS) or Consumer Directed Personal |
Family Size | Medicaid Income Level for Single People & Couples without Children | 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 | Annual | Monthly | ||
1 | $18,755 | $1,563 | $11,200 | $934 | $16,800 |
2 | $25,268 | $2,106 | $16,400 | $1,367 | $24,600 |
3 | $31,782 | $2,649 | $18,860 | $1,572 | |
4 | $38,295 | $3,192 | $21,320 | $1,777 | |
5 | $44,809 | $3,735 | $23,780 | $1,982 | |
6 | $51,323 | $4,277 | $26,240 | $2,187 | |
7 | $57,836 | $4,820 | $28,700 | $2,392 | |
8 | $64,350 | $5,363 | $31,160 | $2,597 | |
9 | $70,863 | $5,906 | $33,620 | $2,802 | |
10 | $77,377 | $6,449 | $36,080 | $3,007 | |
For each additional person, add: | $6,514 | $543 | $2,460 | $205 |
Effective January 1, 2022
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.
If my income is in a Trust, does that impact my Medicaid eligibility?
For more information on Trusts, please visit our Trust-Specific information page.
Can I be eligible for Medicaid even if I make more money than the chart shows?
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.
Expanded Income levels for Children and Pregnant Women
- Infants to age one and pregnant women - 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.
What is the Medicaid Excess Income Program?
- Medicaid Excess Income Program
How long does it take to get Medicaid?
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.
I just want family planning benefits. How do I apply for the Family Planning Benefit Program?
Additional information on the Family Planning Benefit Program, including how to apply, can be found here.
I want to know more about Child Health Plus.
Additional information on Child Health Plus, including how to apply, can be found here.
What are my personal privacy rights?
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?
If you think any decision about your eligibility determination is wrong, or you do not understand any decision, talk to your application counselor or contact NY State of Health customer service center or your LDSS or HRA, depending on where you applied for Medicaid. If you still disagree or do not understand, you have the right to a Conference and an appeal through a hearing.
If you live anywhere in New York State, you may request a fair hearing or appeal by telephone, fax, online, or by writing. How you make the request depends on who made your eligibility decision; a Local Department of Social Service (LDSS) or HRA, or the NY State of Health.
If your eligibility decision was made at the Local Department of Social Service (LDSS) or HRA:
- Telephone: (800) 342-3334 Please 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
If your eligibility decision was made by the Marketplace, (NY State of Health):
- 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
Please keep a copy of any notice for yourself.
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.
The following questions are only for people who are 65 years of age or older, certified blind, certified disabled, or in need of care in a nursing home. These individuals have a resource test.
What are resources?
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)
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?
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.
What is a "lookback" period?
When applying for Medicaid for nursing facility services (Nursing Home), the local department of social services will look at financial transactions to determine whether any assets have been transferred or given away for less than fair market value during a certain time period prior to your application in order to determine if a transfer of assets penalty period needs to be applied. This is known as the "lookback" period. Currently the "lookback" period is 60 months (5 yrs) prior to the month you are applying for coverage of nursing home care.
A penalty period may be imposed for the transfer of non-exempt assets for less than fair market value. The penalty period results in a period of ineligibility for Medicaid coverage of nursing facility services.
A penalty period is not applied for the transfer of your home to the following individuals:
- 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.
For more information regarding the transfer of assets and penalty periods, please contact your local department of social services.
What is a Life Estate? Will it make me ineligible?
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.
Am I allowed to have a pre-paid burial fund?
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.