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Medical Assistance


MEDICAID COMMUNITY SECTION
(PUBLIC HEALTH INSURANCE PROGRAMS)


John H . Mulroy Civic Center 5th floor
421 Montgomery Street
Syracuse, NY 13202

Hours: 8:00 AM- 4:30 PM Monday through Friday
Telephone: (315) 435-2928 Fax: (315) 435-393
8

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.

You can obtain more information online at www.mybenefits.ny.gov.

HOW TO APPLY

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 individuals apply 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:
Birth 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 or dividends
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 property.
Medicare and other health insurance cards and verification of premium cost

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.

 

REVISED 2/9/15

 

 

 
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