What is Medicaid health insurance and how do I apply?

Medicaid is a joint federal and state program for low-income adults, children, pregnant individuals, older adults, and people with disabilities. Each state runs its Medicaid program differently. Each state’s Medicaid program requires that you and/or your family live in the state.  Medicaid health insurance does not transfer from state to state. If you were to move from New York to another state or vice versa, you should close your Medicaid case in the state you currently reside in before relocating and reapplying in your new state of residence.  

Medicaid is comprehensive health insurance. It covers primary and specialist care, medications and medical equipment, hospitalizations, transportation to medical appointments, medical tests like x-rays and labs, and much more.  Medicaid health insurance plays an important role for all low income New Yorkers, but especially for older adults and people with disabilities, including disabled children because it can provide home care services and long-term nursing care when medically necessary.  This is unique to New York State’s Medicaid program since other health insurance like Medicare or employer based insurance will only pay for home or nursing care on a limited and short-term basis. 

Medicaid covered services may be provided using your Medicaid card or through a Medicaid managed care plan, a health insurance plan that must follow Medicaid rules. Some covered services may have small copays. If more than one member of your household has Medicaid health insurance, each of them will have their own Medicaid or managed care plan card.  You use Medicaid health insurance by showing these cards at the doctor, hospital, and/or pharmacy. 

How and where  do I apply for Medicaid?

In order to have Medicaid health insurance, you must apply for the insurance by filing an application. Because the Medicaid program is for low-income people, the application will ask you to provide information about your household, immigration status, income, expenses, including other health insurance, and for certain eligibility groups, about their resources like savings and checking. Medicaid has complicated rules about what income and resources may count to determine your eligibility. It is important for you to provide accurate information about your household when applying for Medicaid.

Where you apply for Medicaid depends on a few factors, including your eligibility category.

• Generally, if you are under 65 years of age, you can apply for Medicaid, Essential Plan, Child Health Plus, and Qualified Health Plans through the NYS of Health Marketplace (NYSOH) or by contacting an enrollment assistor program. 
• If you are 65 years of age and older, disabled or blind, and are not a parent or caretaker relative, you would generally apply for Medicaid health insurance through the Local Department of Social Services (“LDSS”). In New York City, the LDSS is the NYC Human Resources Administration (HRA).  You may also contact a facilitated enroller for the Aged, Blind, and Disabled Program. 

More on how to apply for Medicaid here. 

Do I need to renew my Medicaid health insurance? 

Yes, you have to renew Medicaid coverage yearly. If you do not complete the renewal through NYSOH or the LDSS, your Medicaid coverage and services will end. You should receive a notice in the mail before your Medicaid coverage ends for not renewing.  You can file an appeal with NYSOH if your coverage is through them or a fair hearing with the Office of Temporary and Disability Assistance (OTDA) if your coverage is through LDSS/HRA. You should file an appeal and seek legal assistance if your Medicaid case closes or your services stop. 

For free legal help, call Legal Services NYC at 917-661-4500 Monday through Friday from 9:30 a.m. to 4 p.m. Learn more about our intake process here.

* The information does not constitute legal advice. You should always consult an attorney regarding your matter. Legal help subject to capacity and location.