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HOW TO APPLY FOR NURSING HOME OR HOME CARE MEDICAID BENEFITS
Applications may be mailed or faxed. If providing large amounts of supporting documentation, please mail rather than fax.
Applications (DOH-4220)
If you are over 65 and/ or disabled, you are required to complete a second part of the application, a Supplement A. The Supplement A can be found here.
The Access NY Health Care application (DOH‐4220) includes information about your rights and responsibilities. Information on your rights and responsibilities, and the services and programs available to you can be found here under "Application Booklets."
Medicaid is the payer of last resort (Medicare and private health insurance are billed prior to Medicaid). If you are eligible for Medicare you will be required to apply for Medicare coverage.
Information regarding applying for Medicare can be found here.
WHAT DOCUMENTS WILL YOU BE ASKED TO PROVIDE?
The law requires that you provide documentation to verify your sources of income, your assets, birth date, marital status, and citizenship, as well as some other items. Below is a list of some of the items that will be required. You will receive a detailed list when you receive the application to complete and a prescreening appointment date and time.
• Birth certificates for the applicant and spouse
• Social security cards for the applicant and spouse
• Alien registration card / I-94 card / Naturalization papers for the applicant and spouse
• Marriage certificate or separation papers or divorce papers
• Death certificate(s) of spouse(s)
• Veteran Discharge papers for applicant and /or spouse
• Power of Attorney Papers
• Written Authorization to Represent the Applicant
• Medicare and other health insurance cards and verification of monthly premiums
• Verification of ALL sources of income for the applicant and the spouse, such as but not limited
to: wages, social security, pensions, veterans and military benefits, interest and dividend
income. The gross amounts must be verified, with all deductions, and the frequency with
which the income is received.
• Verification of ALL the assets of both the applicant and spouse MUST be documented. Examples of some types of assets that must be documented are (but not limited to): checking & savings accounts,CD’s, stocks, bonds, mutual funds, retirement funds, annuities, Life insurance policies, burial spaces, burial funds, all properties owned, vehicles, mobile homes and RV’s.
If you are seeking nursing home services, monthly statements for all financial accounts for the 60 months prior to the date of application must be provided. This includes accounts currently closed but that were active at any time in the 60 month look back period. If the applicant or spouse set up a trust or are the beneficiaries of a trust, the trust document must be provided and all assets ownedby the trust must be documented for the 60 months prior to the date of application.
Once an application is received and reviewed if any further documentation is required a pending letter will be issued. This letter will include the name and phone number of the individual processing the application as well as a due date for submission of the information.
RECEIVING A FINAL DECISION
After all the necessary documentation needed to determine Medicaid eligibility has been provided, a decision will be rendered by the Medicaid Office and a formal written notice will be mailed to the applicant, their representative, and the facility or home care provider involved.
If you have any questions, you may contact the Medicaid Chronic Care Unit at 315-435-2928.
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