Am I Eligible?

Medicaid Explanation

Medical Assistance (Medicaid) comes in many varieties to serve varied clientele. On this page we explain what information is available, and explain a few terms common to Medicaid.

Our Income and Resource levels  page gives you the income and resource levels for the many programs that Medicaid represents. For a more direct look at what Medicaid pays for, click here.

If you are interested in applying for Medicaid for Nursing Homes, or are interested in finding out about other Long Term Care possibilities, click here.

For those not seeking or eligible for Chronic Care Medicaid, there is Community Medicaid. This is a level of Medicaid coverage for families, childless couples and individuals. Through Community Medicaid, county residents can receive some level of medical coverage either through direct payment by Medicaid or through a Managed Care program. Families and single individuals (age 21 - 64) are eligible for Managed Care coverage. They are free to select the plan that is best for them among the plans offered, but soon there will be mandatory selection.

Not Eligible for Medicaid?

If you and your family are not eligible for Medicaid, there are a number of other options to make sure you can receive the health coverage your family needs. Family Health Plus is a public health insurance program for adults between the ages of 19 and 64 who do not have health insurance -- either on their own or through their employers -- but have incomes too high to qualify for Medicaid. Family Health Plus is available to single adults, couples without children, and parents with limited income who are residents of New York State and are United States citizens or fall under one of many immigration categories. Family Health Plus provides comprehensive coverage, including prevention, primary care, hospitalization, prescriptions and other services. There are no costs to participate in Family Health Plus. Health care is provided through participating managed care plans in your area. Other health insurance programs sponsored by the State of New York are Child Health Plus and Healthy NY. Click here for Family Health Plus [This link opens a new browser window. When you are done, simply close the new window and this page will be waiting for you ]

Medicaid and Medicare Savings Programs

Our Medicaid and Medicare Savings Programs page gives you a quick overview of how Medicaid can help provide health care for individuals and families in a variety of situations. From dealing with the significant care costs of pregnancy and early childhood to making sure seniors and those with disabilities can afford their Medicare premiums, Medicaid is more than a single one-size-fits-all program. There are ranges of programs and income levels. Click here for further information about Medicaid and Medicare Savings Programs

Some Common Medicaid Terms

SSI-related. These are cases involving people age 65 and over, or those who have been determined disabled (in receipt of Social Security disability or declared disabled for a period of time by a doctor). These people, when budgeted alone or with others are entitled to "spend down"-

Spending down. The income level for eligibility for Community Medicaid is $659.00 a month. If, for example, the person has income of $672.00 (after deductions for any health such insurance including Medicare), then if that person submits thirty dollars worth of medical bills, paid or still owed, then that person may be given "02" or outpatient coverage. Simply put, people in the SSI-related category (that is, those over the age of 65 or declared disabled [in receipt of Social Security Disability]) can spend themselves down monthly into eligibility to pay for further prescriptions. If they accrue hospital bills that are higher than six months worth of spending down, they will eligible for six months worth of Medicaid. The above, of course, assumes that the person is under the $3,950 resource cap. They may, at time of eligibility determination, spend down their resources by allotting the funds to outstanding medical bills. Another area they may need to qualify in is the area of –

Disability. People ages 21–64 are not eligible for the SSI related program unless they are declared disabled. If they can not be noted as disabled, they are budgeted using public assistance Safety Net (Home Relief) categories which uses a lower standard than the SSI related level of $659.00. Only those with income below $371.00 a month would qualify. When we receive applications for Medicaid (either Community or Chronic) we will begin the process of acquiring a disability determination, by referring the case to our Medicaid Expenditure Control Unit (MECU) for a disability determination. The MECU staff gathers the medical information and, after consulting with a physician, will determine the applicant’s disability status. They will then inform the examiner of the applicant’s disability status and how long the disability will last. Some applicant’s will need to have their disability redetermined after a year.

Family. You may hear on occasion that there is a family that has a "spend down." Congress has expanded the Medicaid program to allow families with young children to be eligible even if the parent’s income makes the adults ineligible. Depending on the age of the children, the family can "spend down" by submitting medical bills for those in the family. Please check the Resource Standards page (click here)  for new levels effective January 1, 2004. The Resource Standards page gives the income levels for these "expanded" programs.

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