Medicaid is a program for New Yorkers who can't afford to pay for medical care. It is administered through New York State at both the State and Local level and is a free or "buy into" comprehensive health and dental insurance program, offering complete coverage for all health needs. These services may include doctor visits, in-patient hospital care, emergency services, prescription drugs, medical transportation, and other services that are considered necessary to keep individuals and families healthy. If eligible, Medicaid can cover bills retroactive to three months prior to the date of application.
There are many different types of Medicaid or programs offered by Medicaid; in fact there are more than twenty in all.
Some of the programs available:
• There are programs for families, single or childless couples and the SSI-related population, which consists of the certified blind, certified disabled and people over 65 years of age.
• If families with children under 21 or the SSI-related population are over income and/or resources for Medicaid, they can choose to spend down this excess. For example, if they are over income by $10.00 per month, they can choose to pay Medicaid $10.00 or submit paid or incurred bills to the Agency for that month and we will "turn on" their Medicaid.
• SSI (Supplemental Social Security) cash recipients are automatically eligible for Medicaid, and while the SSA determines their eligibility, the local counties are responsible for administering the Medicaid.
• Medicaid has expanded income levels for pregnant women and children under the age of 19. In addition, babies born on Medicaid are guaranteed eligibility for one year from birth and moms are guaranteed eligible for two months postpartum.
• Medicare Savings Program offers benefits to people who are in receipt of Medicare. If eligible, Medicaid may pay their Medicare premium, and depending on their income, their co-insurance and deductibles.
• Cobra Continuation Program - available for people who lose their health insurance through employment ending. If eligible, Medicaid can pay the health insurance premium for up to 18 months.
• Expanded eligibility for HIV-related individuals.
• Family Planning Benefit Program - for individuals of child-bearing age who are not otherwise eligible for Medicaid or opt for this coverage only. It offers Medicaid reimbursed family planning services.
• Presumptive Pregnancy Care and Presumptive Home Health Care is available for people in need and they can be determined "presumptively eligible" for Medicaid services for 45 days.
• Nursing Home Care - In addition to paying for nursing home care for individuals, Medicaid utilizes spousal impoverishment guidelines to ensure that spouses living in the community are allowed to keep adequate income and resources while their spouse is being cared for.
• Transitional Medicaid is available for some people who are making the transition from Medicaid or Temporary assistance to employment. These individuals are guaranteed eligibility for one year.
• The Disabled Client Assistance Program is a mechanism where Medicaid can assist disabled clients, who would not be otherwise eligible, with the paperwork that is needed to get them a disability determination for Social Security requirements.
These are a sampling of the different programs that Medicaid offers. There are different income levels and guidelines for each program, as well as varying degrees of coverable services that Medicaid will pay for.
Eligibility is determined by a number of different factors, such as age, health, household composition, as well as income and resources.
HOW TO APPLY: Online at www.healthbenefitexchange.ny.gov; by calling 1-855-355-5777, 1-800-231-0744 or 1-888-962-8244; or by mailing an application to your local Department of Social Services.
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