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Medicaid and Family Health Plus

Health Insurance for Adults: Medicaid and Family Health Plus

Medicaid provides free health insurance for low-income adults. Eligible adults receive their medical care through a managed care plan or fee-for-service. While your application is being processed, Medicaid may provide up to 90 days of retroactive coverage for unpaid medical bills, if you are eligible during those 90 days.

 

Eligibility Requirements Include:

  • Age: Adults between the ages of 19 to 64 years old. Medicaid is also available for individuals over 65 years old.
  • Identity/Date of Birth:  See Document Check List 
  • Residency: Must be a New York State resident
  • Citizenship/Immigration Status: Can be a U.S. citizen or fall under one of many immigration categories. Undocumented immigrants and people on short-term visas who are not in the process of applying for permanent status are not eligible.
  • Assets: The resource (asset) test has been eliminated for applicants/recipients who are not aged (65 or  older),  certified blind or certified disabled.
  • Income: Please see chart below for monthly income levels.
Medicaid Income Levels
(Parents, 19 and 20 year olds, 21-64 years old who are disabled, 65 and over)
This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.
Family Size Yearly Income Monthly Income Weekly Income Resource Level* 
1 $9,600 $800 $185

$14,400

2 $14,100 $1,175 $271 $21,150
3 $16,224 $1,352 $312 $24,323
4 $18,336 $1,528 $353 $27,495
5 $20,448 $1,704 $393 $30,668
For each additional person add: $2,124 $177 $41 $3,173

NOTE: Chart effective January 1, 2013; subject to annual income updates. 

* The resource test applies to applicants/recipients who are aged (65 or  older), certified blind or certified disabled.

 


Benefits Covered by Medicaid

Medicaid covers medically necessary care including:

  • Regular checkups;
  • Hospital inpatient and outpatient services;
  • Emergency room care;
  • Prescription drugs;
  • Specialist care;
  • Home health care;
  • Nursing home care;
  • Dental care;
  • Prenatal care;
  • Smoking cessation agents;
  • Medical supplies and equipment.

 

Delivery of Service

For enrollment into Medicaid, 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. If the applicant 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.

Some Medicaid eligible adults may be exempt or excluded from managed care enrollment.  Please see an enrollment counselor for more information.

Where to Enroll in Medicaid
Individuals can call 311 and ask for the HRA Medicaid helpline to find out if they are eligible for Medicaid. Enrollment counselors are available to enroll adults 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 Medicaid programs, please contact an agency listed below:
Human Resources Administration at 1-718-557-1399
New York State Department of Health at1-800-541-2831 or visit its website at New York State Department of Health

 

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.

Eligibility Requirements Include:

  • Age: Adults must be between the ages of 19 to 64 years old
  • Identity/Date of Birth:  See Document Check List 
  • Residency: Must be a New York State resident
  • Citizenship/Immigration Status: Can be a U.S. citizen or fall under one of many immigration categories. Undocumented immigrants and people on short-term visas who are not in the process of applying for permanent status are not eligible.
  • Health Coverage: Adults can not have other health insurance coverage (there are some limited exceptions)
  • Assets: The resource (asset) test has been eliminated for all Family Health Plus applicants/recipients.
    Income
    : Please see chart below for monthly income levels.
Family Health Plus
Gross Income Levels
 
This chart is only a guide. Individuals should see an enrollment counselor for eligibility screening.
Family Size Yearly Income Monthly Income Weekly Income
Single Adult and 19-20 Year Olds Living Alone $11,496 $958 $221
Couples with No Children $15,516 $1,293 $298
1* $17,244 $1,437 $332
2* $23,268 $1,939 $447
3* $29,304 $2,442 $564
4* $35,328 $2,944 $679
5* $41,364 $3,447 $795
For each additional person add: $6,036

$503

$116
NOTE: Chart effective January 1, 2013; subject to annual income updates.
* Parent living with at least one child under 21; 19-20 year olds living with their parents   

 

Benefits Covered by Family Health Plus

Some of the benefits include:

  • Regular checkups;
  • Hospital inpatient and outpatient services;
  • Emergency room care;
  • Prescription drugs;
  • Specialist care;
  • Smoking cessation agents;
  • Medical supplies and equipment.

 

Family Health Plus Co-payments

Effective September 1, 2005, certain Family Health Plus services will require co-payments.  All co payments should be paid directly to the medical provider.  Providers can not refuse you service if you are unable to pay the co-payment.  However, if you are unable to pay at the time of service, you may be billed for the co-payment amount owed.

Delivery of Service
Health care is delivered through a managed care plan. A managed care plan must be selected at the time of enrollment.

 

Where to Enroll in Family Health Plus
Individuals can call 311 and ask for the HRA Medicaid helpline to find out if they are eligible for Family Health Plus. Enrollment counselors are available to enroll adults 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

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