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NOTE: OUR COMMUNITY PARTNER’S INFORMATION IS FOR PARTNERS OF DSS-ES & IS NOT DIRECTED FOR THE PUBLIC OR REGARDING INFORMATION ABOUT PUBLIC BENEFITS AND SERVICES.
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Commissioners Office
John H. Mulroy Civic Center
421 Montgomery St.
Syracuse NY, 13202

Hours:
Mon-Fri, 8am-4pm

 

ATTENTION: If you have a change in address or are planning to have a change in address, please contact us at (315)-435-2928.

 

Medical Assistance - How To Apply

 

MEDICAID CHRONIC CARE

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.

 

 

MEDICAID COMMUNITY

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 category. 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 relatives

 

THE FOLLOWING INDIVIDUALS APPLY WITH THEIR LOCAL DEPARTMENT OF SOCIAL SERVICES (LDSS) BY CALLING (315) 435-2928

Individuals age 65 and older, who are not parents or caretaker relatives, when age is a condition of eligibility
• Individuals whose eligibility 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 Eligibility (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

HOW TO SEND US YOUR DOCUMENTS:

 

You can mail copies of your documents via the US Postal Service, Fax them to 315-435-3938, drop them off in the drop box, located on the Madison St side of the Civic Center, or you can use the NYDocSubmit App.
Using the NYDocSubmit App is easy! Applications cannot be submitted Just download it from Google Play or the Apple App store, take a photo of a document, Enter Identifying Information, and upload the Document

 

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.

 

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

APPLICATIONS FOR THE MEDICARE SAVINGS PROGRAM MAY BE OBTAINED BY CALLING (315) 435-2928

If you have any questions, you may contact the Medicaid Community Unit at (315) 435-2928.

 


 

 

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