Medicaid is a program that provides health coverage to some low-income New York residents. Medicaid covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met.  Single individuals and childless couples may also be eligible if their income is below the cash assistance standard of need for their county of residence.  Other legal residents who are not U.S. citizens may be eligible for Medicaid if they have emergency needs.  Enrolling in Medicaid or Child Health Plus will not affect an immigrant family’s ability to get a green card or become a citizen.

• For certain categories of people, eligibility for Medicaid is based on the amount of their household income.

In New York you may be eligible for Medicaid if you are an infant, a child, a pregnant woman, or a parent of a child, and your family income meets the Medicaid income standards.

Income eligibility levels for these categories are described below. Your assets and some expenses also may be taken into account, so you should contact you local department of social services for more information.

Low-income persons eligible for Medicaid in New York*

Category - Income eligibility (as percent of federal poverty level)
Infant - 200% (monthly income of about $2,612 for family of 3)
Child 1-5 - 133%
Child 6-18 - 100%
Parent - 150%
Pregnant woman - 200%

* Eligibility information was compiled from State Health Facts Online and the Henry J. Kaiser Family Foundation, and may have changed since this guide was published.  Contact your local department of social services for the most up to date information and for other eligibility requirements that may apply.

• Families who get cash benefits from Temporary Assistance for Needy Families (TANF) (also known as the Family Assistance Program or FAP) can get Medicaid.
  
• Parents should know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period.
• Parents should know that when your family’s TANF benefits end, your children may also qualify for transitional Medicaid coverage for 12 months.  Or, they may qualify for Medicaid themselves if your family’s income meets the Medicaid income standards. (See below.)
• Continuous Medicaid coverage for children (up to the age of 19) is provided for 12 months following eligibility determination regardless of any changes in income or circumstances.
• Very poor elderly or disabled people who get Supplemental Security Income (SSI) benefits can also qualify for Medicaid.

Disabled individuals should know that if your income earned from a job increases so that you no longer qualify for SSI, you may be able to continue your Medicaid coverage at least for a limited time.

To get an idea of how your income compares to the federal poverty level,* use the federal poverty guideline issued by the U.S. Department of Health and Human Services for the year 2006:

Size of Family Unit                         Poverty Guideline (annual income)

               1                                       $   9,800

               2                                       $ 13,200

               3                                       $ 16,600

For larger families, add $3,400 for each additional person

So, for example, using this guideline, 200% of the federal poverty level for a family of 3 would be an annual income of $33,200, or a monthly income of $2,767.

* Contact your local department of social services for the most up to date information and for other eligibility requirements that may apply.

• People who have high medical expenses may also qualify for Medicaid. You may qualify as medically needy if you have high medical expenses that, when subtracted from your income, would make you eligible for Medicaid coverage. For example, people who have to pay a lot for prescription drugs, nursing home care, or other long term care services sometimes qualify as medically needy if they don’t have health insurance that covers these services.
• Retired or disabled people who have low-incomes and are enrolled in Medicare may also qualify for help from Medicaid. Even though your income may be too high to qualify for Medicaid insurance coverage, there may be other ways Medicaid can help you.

If your household income is below the poverty level, Medicaid will pay your Medicare monthly premium and your Medicare deductibles and coinsurance.  This is called the Qualified Medicare Beneficiary (QMB) program. 

If your household income is between 100% and 120% of the federal poverty level, Medicaid will pay for your monthly Medicare premiums only.  This is called the Specified Low-Income Medicare Beneficiary (SLMB) program.

Contact your local department of social services for more information about other eligibility requirements.

• There may be other ways that Medicaid can help. To find out if you or other members of your family qualify for Medicaid, contact the department of social services.

To obtain the locations and telephone number of an office near you, call the New York State Department of Health at (518) 486-9057, or visit the internet at www.health.state.ny.us/nysdoh/medicaid/main.htm.