Do You Qualify for Medicaid in New York State?

Medicaid Eligibility and Income Requirements for New York

Medicaid is a government sponsored program that covers medical expenses for low-income patients who cannot otherwise afford healthcare services.  Not to be confused with “Medicare”, which is an insurance program, Medicaid is actual assistance provided by government.  The main difference between the two is that Medicare serves primarily older adults aged 65 and up, whereas Medicaid covers low-income people of all ages.  Medicare is a federally funded program where patients pay a percentage of their medical costs through deductibles and the rules are generally the same in all 50 states.  However, Medicaid is run by state and local governments, and out-of-pocket costs are pretty much next to none.

Medicaid covers a broad range of healthcare services including doctor visits, hospital stays, nursing home care, home health care, and more.  The amount you have to pay for copay will be relatively small and your prescription drugs may also be covered.  Of course, you will have to qualify to receive these benefits.

New York’s state department has developed several factors to determine who is eligible for these benefits.  If you’re unable to pay for your medical bills and are on other programs such as SSI (Supplemental Security Income), for example, you may be able to qualify for Medicaid as long as your income level does not exceed 138% of the Federal Poverty Level (FPL).

There are other predetermined eligibility requirements aside from having an income that is at or below the FPL.  You may have to maintain certain income levels without going past the income thresholds.  Generally, the following items will be needed to start the process in determining eligibility:

  • Proof of U.S. citizenship and resident of New York State
  • Documentation regarding your living situation
  • Marriage certificate if you are married
  • Social security number

The income requirements will be different depending on your age, disability, marital status, and family size.  Your assets will also be accounted for in determining your eligibility.  Financial requirements are more relaxed for those who are over the age of 65, blind, or otherwise disabled.  But in general, your income should not exceed 138% of the FPL for your family or household size. 

The chart below shows each income level according to the number of persons in your household:

For specific information on income requirements based on household size, visit the New York State Department of Health website:  https://www.health.ny.gov/health_care/medicaid/#income

Estimated benefit amounts usually depend on the individual patient and services needed.  New York State requires specified documentation to assess patient needs.  The most common documentation are listed below.  You can use this checklist to help you gather the required items to begin your entitlement process:

MEDICAID DOCUMENTATION CHECKLIST

(When applicant is married, all information must be for BOTH spouses)

VERIFICATION OF AGE AND CITIZENSHIP

(One MAY be enough, but MUST have photo ID)

•             Passport (can be expired)

•             Birth Certificate, Baptismal Certificate

•             Social Security Card

•             Naturalization papers, if applicable

VERIFICATION OF MONTHLY INCOME (Social Security, Pension, Annuity, etc.)

•             Copy of Social Security Award Letter

(Call 800-772-1213 for proof of income letter if you do not have your Social Security Award letter)

•             Copy Pension Award Letter

•             If receiving a distribution from an IRA please include proof of monthly amount

•             If receiving any rental income from any properties, please include proof of monthly amount.

VERIFICATION OF RENT & RELATED EXPENSES

•             Rent receipt, deed to house, telephone, gas & electric bills

HEALTH INSURANCE (Blue Cross/Blue Shield, AARP, HIP, HMO, etc.)

•             Copy of insurance card(s) Need copy of front and back

•             Proof of Premiums (copy of premium notice(s) and/or copy of cancelled checks showing   Payment of premium(s)

MEDICARE

•             Copy of Medicare card – Need copy of front and back

PROOF OF MARITAL STATUS

•             Copy of marriage certificate/separation papers

•             Divorce decree and/or Death Certificate

VETERAN STATUS

•             Discharge Papers

WHOLE LIFE INSURANCE (Choose one)

•             Copy of Insurance Policy

•             Statement from insurance company stating current cash value

REPARATIONS (i.e. German, Austrian, Japanese-American, Agent Orange Payments)

•             Copy of check or affidavit or receipt of Reparations

•             Proof of total received

FINANCIAL STATEMENTS

•             Past 3 months of any open bank statements, passbooks, stocks, bonds, CD’s, IRA’s, Annuities, etc.)

BURIAL DEED

•             Pre-paid Burial Documents

Our team of experts at Xtreme Care are dedicated to helping individuals quickly and easily understand the programs they might be eligible for.  We will research and provide you with the most relevant information according to your own situation.  Give us a call today at 718-461-9602 or email us at info@localhost.