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Your Quick Guide to Medicaid in New York

Medicaid is a public insurance program in New York that was created in 1965 to provide health coverage to men, women, children, seniors, pregnant women, people with disabilities, and others from low-income backgrounds.

In 2018, Medicaid in New York gave 97 million low-income individuals health coverage. According to the Congressional Budget Office (CBO), Medicaid helps 32 million children, 28 million adults, 6 million seniors, and 9 million individuals with disabilities every month.

Key Takeaways

  • Medicaid is an insurance program that provides health coverage to low-income families.
  • Pregnant women and others from families with an income of 138% of the federal poverty line can sign up for Medicaid.
  • People with disabilities or families housing them can sign up for Medicaid.
  • You can resubmit your Medicaid application if it gets rejected the first time – it’s also possible to appeal the initial rejection.
  • Check if you are eligible for Medicaid here. 

What Is Medicaid?

Every state has its own Medicaid program since federal guidelines are quite extensive, giving them the flexibility to design and administer their program.

Medicaid expands its enrollment during economic downturns because people typically lose their jobs and must let go of their job-based health coverage. During and after the Great Recession of 2007, more than 10 million people – half of them children – signed up for Medicaid. Similarly, enrollment rose in the months of COVID-19 as public health was at risk and the nation geared up for an economic crisis.

Since Medicaid is an entitlement program, individuals must meet the eligibility rules before enrolling in the coverage.

Who Is Eligible for Medicaid in New York?

Since states rely on federal financial support to finance their Medicaid programs, they must meet the following population requirements:

  • Children must be part of families with an income lower than 138% of the federal poverty line. Moreover, they must be below the age of 18. In 2020, this meant $29,974 for a family of three individuals.
  • Pregnant women with an income of less than 138% of the poverty line.
  • People with disabilities and seniors who use the Supplemental Security Income (SSI) to receive cash assistance.
  • Someone who has dependents with disabilities.
  • Adults over the age of 21 are not eligible for Medicaid, regardless of how low their incomes are, unless they have a disability or are seniors or children.
  • Even if they have lawfully immigrated, people who are not US citizens are not eligible for Medicaid.

Annual Household Income Limits

Household SizeMaximum Income Level

What Services Does Medicaid Offer?

Medicaid offers several health services, including:

  • Clinic visits
  • Doctor visits
  • Immunizations
  • Lab tests
  • X-rays
  • Medical supplies
  • Emergency care
  • Eye care and eyeglasses
  • Nursing home care
  • Hospital stays
  • Ambulance to the hospital in emergencies
  • Dental care
  • Regular medical checkups and follow-up care
  • Medical equipment and necessities, such as wheelchairs.

Pregnant women who have a high income and do not qualify for Medicaid can still take advantage of perinatal care.

Children up to 21 years of age are eligible for the Child/ Teen Health Program (C/THP), which provides the same health services as Medicaid. The only difference is that C/THP focuses more on preventive care and treatment.

For instance, Medicaid instructs children between one and two years of age need to be screened for a blood lead test. C/THP is a fee-for-service program that healthcare providers offer.

Moreover, managed care plans must provide C/THP to Medicaid recipients younger than 21 years of age. Managed care plans allow eligible adults and children to use services.

How Do I Apply for Medicaid in New York?

Step 1: Determine Your Eligibility Criteria

The way individuals apply for Medicaid depends on where they fall on the eligibility criteria. Some can use it through the NY State of Health, while others must apply through their Local Department of Social Sciences (LDSS).

NY State of Health helps determine one’s eligibility in compliance with Modified Adjusted Gross Income (MAGI) Rules. Usually, the same rules of the Internal Revenue Service (IRS) are used to determine income – conditions applied.

Those already part of the MAGI eligibility groups need to apply with the NY State of Health. This includes:

  • Children between 1 to 18 years of age
  • Infants under the age of 1
  • Adults who are not eligible for Medicaid and are 19 to 64 years of age
  • Pregnant women
  • Caretaker relatives and parents who have Medicare
  • Those who are part of non-MAGI eligibility groups can apply with their Local Department of Social Services (LDSS). This includes:
    • Those who are older than 65 years of age do not have any caretakers.
    • Blind or disabled individuals who do not fall in any MAGI eligibility groups. This includes individuals needing Consumer Directed Personal Assistance Services (CDPAS) or Personal Care Services (PCS).
  • Those eligible for COBRA, AIDS Health Insurance Program (AHIP), screened for Presumptive Eligibility (PE), youth who are in foster care or have been in foster care, Medicare Savings Program (MSP), Medicaid Buy-In Program for Working People with Disabilities.

Eligibility may also be affected by the following:

  • Income
  • Size of one’s family/ household
  • State residency
  • Immigration/ citizenship status

Step 2: Gather Necessary Information

Medicaid applications get rejected because of incomplete data. Therefore, before submitting the Medicaid application, ensure you have collected all necessary information. This includes:

  • Birth certificate
  • Proof of citizenship
  • Proof of income (Social Security, Veteran’s benefits, Supplemental Security Income, paystubs or tax return, or any other income for alternate sources)
  • Proof of assets, bank statement copies, and financial resources mentioned on the Medicaid application
  • Proof of residence, including rent receipts, any recent mail sent to your present address, and a photocopy of your mortgage form
  • Proof of any other insurance- throw in a copy of your blue, white, or red Medicare with your Medicaid application

Keep in mind that Medicaid applications and requirements differ based on state requirements, so visit the appropriate website to gather additional documentation. You can write, phone, or go to your legal department of social services to reconfirm the necessary documents. You may also visit the Medicaid website.

Step 3: Submit the Application

Follow all the instructions laid down by your state when submitting the Medicaid application. These applications may be submitted in several ways, including online and paper applications, or you can even drop the applications off at the Medicaid office in your area.

Every state takes 45 days to respond to regular Medicaid applications, while disability applications can take up to 90 days.

You can appeal if your Medicaid application does not get approved. If the application was rejected because of missing documentation or information, get all the necessary information and send in the application again. In case of any confusion, look through the Medicaid denial letter and follow the instructions.


Medicaid in New York is an excellent opportunity for low-income individuals and families to obtain health coverage.

Every state has different Medicaid application and eligibility requirements, but most remain similar to the ones mentioned in this guide.

To recap, those belonging to families with an income of less than 138% of the federal poverty line and individuals with disabilities or households living with individuals with disabilities. Non-US citizens and individuals over 21 years of age are not eligible for Medicaid, regardless of how low their incomes are.

As long as all documents are submitted, and you meet the requirements, you can become a part of New York’s Medicaid program.

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