The Medicaid Community Unit processes applications for a variety
of public health insurance programs including Medicaid, Prenatal care services (Presumptive Eligibility), Family Planning Benefit
Program and the Medicare Savings Program.
Financial eligibility is determined based on the income and resource standards
governing the Public Health Insurance Programs. A Supplemental Security Income
recipient is granted Medicaid based on his/her certification for SSI benefits. A
separate application for Medicaid is not needed for SSI recipients.
Persons eligible for Medicaid may be required to enroll in a
managed care plan. Managed Care information and options will be provided upon application.
Individuals may apply for Medicaid in the following ways:
NY State of Health, The Official Health Plan Marketplace (855) 355-5777
Online at nystateofhealth.ny.gov
Managed Care Organization (MCO)
Navigators and Certified Application Counselors
Local District Social Services Offices
WHERE individuals apply for Medicaid will depend on their catagory. The Marketplace determines eligibility using Modified Adjusted Gross Income (MAGI) rules. The Following individualsapply with New York State of Health Marketplace:
Adults (not pregnant) and aged 19-64, NOT eligible for medicare
Pregnant Women and Infants
Children ages 1-18
Parents and caretaker reletives
THE FOLLOWING INDIVIDUALS APPLY WITH THEIR LOCAL DEPARTMENT OF SOCIAL SERVICES (LDSS)
Individuals age 65 and older, who are not parents or caretaker relatives, when age is a condition of eligibility
Individuals whose eligilibility is based on being blind or disabled or who request coverage for community based long term care services (CBLTC)
Medicare Savings Program (MSP)
Medicaid buy-in for Working People with Disabilities enrollees (MBI-WPD)
Residential treatment center/community residences operated by the Office of Mental Health (OMH)
Presumptive Eligilibility (PE) for pregnant women apply with provider, processed by the LDSS
WITH THE APPLICATION THE FOLLOWING DOCUMENTATION MUST BE PRESENTED:
Certificates for all persons who are applying
Social Security Card for all who are applying
Proof of citizenship status
Veteran Discharge papers (if applicable)
Verification of ALL income, including but not limited to: wages,
Social Security, pensions, veteran’s benefits and interest
Depending on your circumstances you may be asked to verify ALL your resources, including but not limited to: bank accounts, trust
funds, insurance, CDs, burial accounts, burial spaces, vehicles and
Medicare and other health insurance cards and verification of premium
RECEIVING A FINAL DECISION
After all the necessary documentation
needed to determine eligibility has been received, a decision will
be rendered by the Medicaid office and a formal written notice
will be mailed to the applicant and to their representative.
If the applicant does not agree with the written decision the notice
includes information on how to apply for a Fair Hearing through
the New York State Department of Health
PREGNANT WOMEN MAY APPLY FOR PRENATAL CARE SERVICES (PE) AT THE FOLLOWING SITES:
Family Planning (315) 435-3295
Planned Parenthood (315) 475-5540
St. Joseph's Maternal Child Health Center/St. Joseph's family medicine (315) 448-6146
Syracuse Community Health Center (315) 476-7921 ext 2327
UHCC/Womens Health Care Services (315) 464-5210
APPLICATIONS FOR THE MEDICARE SAVINGS PROGRAM MAY BE OBTAINED BY CALLING (315) 435-2928
RENEWAL OF ELIGIBILITY & REPORTING RESPONSIBILITY
If you are found eligible for ongoing Medicaid or another Public
Health Insurance Program you will be required to re-establish your
eligibility at regular intervals as determined by the New York
State Social Welfare law. This is called a “Renewal”.
You will receive notification of your renewal and a renewal form
by mail. It must be retuned by the date in the notice for your
benefits to continue.
Social Services law requires that you report any changes in your
income, resources, third party health insurance, family composition and residence to the Medicaid
office. You may also be contacted by the department if a computer
income match indicates a change in your circumstances.
If you have any questions, you may contact the Medicaid Community
Unit at (315) 435-2928.