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Coverage for Children


Health Insurance for Children: Medicaid and Child Health Plus 

Medicaid (coverage for children)  is available for many children in working families. Most children who are eligible for Medicaid (coverage for children) will receive their medical care through a health plan, and visit doctors and hospitals that accept that health plan. While your application is being processed, Medicaid (coverage for children) may provide up to 90 days of retroactive coverage for unpaid medical bills, if eligible during those 90 days.

What is Child Health Plus?
New York's two health insurance programs for children are Medicaid (coverage for children) and Child Health Plus. Child Health Plus is a comprehensive health insurance program that covers a wide range of children's health care and dental needs. The income requirements make it possible for working families to get free or low-cost health insurance for their children.

 

Eligibility Requirements Include:

  • Age: Children must be under the age of 19 years old
  • Identity/Date of Birth:  See Document Check List 
  • Residency: Must be a New York State resident
  • Citizenship/Immigration Status: Can be U.S. citizen or an immigrant. Most immigrants in New York State are eligible – except for undocumented immigrants and people on short-term visas who are not in the process of applying for permanent status.
  • Income: Please see chart below for monthly income levels.

Medicaid (coverage for children) and Pregnant Women
Monthly Income Levels*

This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.

Age Categories for Children Monthly Income for Family Size Each Additional Person, Add:
1 2 3 4 5
Children Under 1 Year old;
Pregnant Women Perinatal Coverage Only**
$1,915 $2,585 $3,255 $3,925 $4,595 $670
Children 1 - 18 years old $1,274 $1,720 $2,165 $2,611 $3,056 $446
Children 19-20 years old $800 $1,175 $1,352 $1,528 $1,704 $177
Pregnant Women** Full Coverage
$1,293 $1,628 $1,963 $2,298 $335
* Please see an enrollment counselor for additional program information and requirements.
** Pregnant Women count as two individuals.
NOTE: Chart effective January 1, 2013 subject to annual income updates.

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Benefits Covered by Medicaid (coverage for children) 

Some of the benefits include:
  • Regular checkups;
  • Immunizations;
  • Hospital care;
  • Emergency room care;
  • Prescription drugs;
  • Dental care;
  • Eyeglasses;
  • Specialty care;
  • Medical equipment.

 

Delivery of Service

For enrollment into Medicaid (coverage for children), a managed care plan does not have to be selected at the time of enrollment.  Medicaid applicants have 60 days to choose a health plan.  New York Medicaid CHOICE notifies Medicaid eligible persons by mail, of the requirement to enroll into a Medicaid managed care plan following initial determination of eligibility for Medicaid (coverage for children). If the consumer does not return the enrollment form or contact New York Medicaid CHOICE, the following actions will be taken by New York Medicaid Choice.

  1. A 30-day reminder notice is mailed out. 
  2. 15 days before 60 days are up - the consumer receives a 2nd reminder notice and is notified of pending AUTO-ASSIGNMENT into a health plan, the name of the health plan and the effective date of enrollment. 
  3. On the 60th day, the consumer is enrolled into that health plan

Telephone Enrollments: To avoid auto-assignment into a health plan, applicants can enroll by telephone at any time by calling New York Medicaid CHOICE 1-800-505-5678.  Enrollment is confirmed by mail.

Where to Enroll in Medicaid (coverage for children)
Individuals can call 311 and ask for the HRA Medicaid helpline to find out if they are eligible for Medicaid (coverage for children). Enrollment counselors are available to enroll children into Medicaid at convenient neighborhood locations. Counselors are located at Medical Assistance Program Offices, community-based organizations, hospitals and health plans to assist individuals in filling out an application. It is important to see an enrollment counselor to assist you with the application process because factors other than those noted above are considered to determine eligibility.

Find out where you can enroll in your neighborhood

Documentation Check List
Bring a copy of the following documents (in PDF): your last four pay stubs, proof of age, address, identity, and immigration status (for adults only) to your appointment with a health insurance enrollment counselor.

 

Other Helpful Resources
For more information regarding this and other public health insurance programs, please contact an agency listed below:
Human Resources Administration at 1-718-557-1399
New York State Department of Health at 1-800-541-2831 or visit its website at New York State Department of Health


Child Health Plusprovides free or low-cost health insurance for children under the age of 19 who are not eligible for Medicaid, coverage for children. All children receive their health care through a managed care plan. There are no immigration requirements for Child Health Plus.

Eligibility Requirements Include:

  • Age: Children must be under the age of 19 years old
  • Identity/Date of Birth:  See Document Check List 
  • Residency: Must be a New York State resident
  • Health Coverage: Children can not have other health insurance coverage (there are some limited exceptions)
  • Income: Depending on a family’s income, Child Health Plus B is free for some families and others have to pay a small monthly premium.Families with higher incomes can also purchase health coverage for their children at the full premium level. Please see chart below for monthly income levels.
Child Health Plus (Children Under 19 who are not eligible for Medicaid) Monthly Income Levels
This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.
 
Premium Categories Monthly Income for Family Size Each Additional Person, Add:
1 2 3 4 5
Free Insurance $1,531 $2,067 $2,603 $3,139 $3,675 $536
$9 Per Child Per Month (Maximum of $27 per family)
$2,126 $2,870 $3,614 $4,357 $5,101 $744
$15 Per Child Per Month (Maximum of $45 per family) $2,394 $3,232 $4,069 $4,907 $5,744 $838
$30 Per Child Per Month (Maximum of $90 per family) $2,873 $3,878 $4,883 $5,888 $6,893 $1,005
$45 Per Child Per Month (Maximum of $135 per family) $3,352 $4,524 $5,697 $6,869 $8,042 $1,173
$60 Per Child Per Month (Maximum of $1820 per family) $3,830 $5,170 $6,510 $7,850 $9,190 $1,340
Full Premium Per Child Per Month** Over $3,830 Over $5,170 Over $6,510 Over $7,850 Over $9,190 $1,340

* Pregnant Women count as two individuals.

** Full premium amounts vary, depending on the health plan. Current premium levels average $182  per child per month.
NOTE: Effective January 1, 2013 subject to annual income updates.

 

Benefits Covered by Child Health Plus

Some of the benefits include:

  • Regular checkups;
  • Immunizations;
  • Hospital care;
  • Emergency room care;
  • Prescription drugs;
  • Dental care;
  • Eyeglasses;
  • Specialty care;
  • Medical equipment.

 

Delivery of Service

Health care services are delivered through a managed care plan.  A managed care plan must be selected at the time of enrollment. 

 

Where to Enroll in Child Health Plus
Individuals can call 311 and ask for the HRA Medicaid helpline to find out if they are eligible for Child Health Plus. Enrollment counselors are available to enroll children into Child Health Plus  at convenient neighborhood locations. Counselors are located at community-based organizations, hospitals and health plans to assist individuals in filling out an application. It is important to see an enrollment counselor to assist you with the application process because factors other than those noted above are considered to determine eligibility.

Find out where you can enroll in your neighborhood

Documentation Check List
Bring a copy of the following documents (in PDF): your last four pay stubs, proof of age, address, identity, and immigration status (for adults only) to your appointment with a health insurance enrollment counselor.

 

Other Helpful Resources
For more information regarding this and other public health insurance programs, please contact an agency listed below:
Human Resources Administration at 1-718-557-1399
New York State Department of Health at 1-800-541-2831 or visit its website at New York State Department of Health



 



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