Support > Benefits and Entitlements

Medicaid

Title XIX of the Social Security Act created a program which provides medical assistance for certain individuals and families with low incomes and low resources. The program, known as Medicaid, became law in 1965 as a jointly funded cooperative venture between the federal and state governments to assist states in providing adequate medical care to eligible needy persons.

Is It For Me?

The following chart shows how much monthly net income and assets you can have and still qualify for Medicaid. These numbers vary with the number of persons in the household and are subject to yearly adjustments.

If you are aged, blind or disabled and have income over these income levels, you may still qualify for Medicaid if you have medical bills that are equal to or more than the amount of your excess income. This is possible under the Excess Income Program. For more information about this program, contact your local Department of Social Services office. See below for a list of addresses and phone numbers of the four Westchester County Department of Social Service centers.

You may be eligible to receive Medicaid if you receive Public Assistance or Supplemental Security Income (SSI), or if you meet certain income, resource, age or disability criteria.

There are also special programs to help if you are pregnant or if you have a child. If you are pregnant, a social worker at the clinic or hospital you are using for prenatal care can assist you in applying for Medicaid.

Pregnant women and children may also be eligible for Medicaid if their income and/or resources are above these levels, and they have medical bills.

Expanded Income Levels for Children and Pregnant Women

• Infants to age one and pregnant women - 200% of the Federal Poverty Level (FPL)
• Children age one to 19 years - 133% of the Federal Poverty Level (FPL)

The Westchester County Medicaid Managed Care Program provides the prepaid health services to you if you are eligible for Medicaid. The County provides Managed Care through contracts with five health plans. If you are a Medicaid recipient you may be required to join one of these five plans. These plans offer coverage very similar to traditional Medicaid services. Westchester County oversees the health plans with ultimate oversight belonging to New York State. The County performs all enrollment and dis-enrollments in the Managed Care Program. Call the Managed Care help line, 800-549-7650 from 8:30 AM until 5:00 PM, weekdays with your questions and to get additional information.

You can also log on to http://www.westchestergov.com/social/MA/ManagedCare.htm for further information.

Even if you are not eligible for Medicaid because you don’t fit the income eligibility, you and your family may still receive help with medical costs. Transitional Medical Assistance (MA) provides continued medical assistance coverage to you if you become ineligible for Medicaid or TANF (Temporary Assistance for Needy Families) but you have a dependent child under the age of 21 living with you. Transitional Medical Assistance benefits are available for six months to you if you lose Medicaid due to new employment or increased earned income. An additional six months of Medical Assistance may be possible if you remain employed, have earned income below a certain level and have a dependent child under the age of 21 living with you.

New York State has a health insurance plan for your children up to 19 years of age who do not qualify for Medicaid called Child Health Plus. Children under the age of 19 who are not eligible for Medicaid and who have limited or no health insurance may be eligible for Child Health Plus. Even if you have family income above the poverty level, as a New York State resident you can enroll your child in Child Health Plus. Depending on your gross family income, you may have to pay a family contribution to enroll in Child Health Plus. This health insurance plan is available through dozens of providers throughout the state and covers the following services:

• Well-child care
• Physical examinations
• Immunizations
• Diagnosis and treatment of illness and injury
• X-rays and lab tests
• Outpatient surgery
• Emergency care
• Prescription drugs
• Inpatient hospital, medical or surgical care
• Short-term therapeutic outpatient services (chemotherapy, hemodialysis)
• Limited outpatient treatment for alcoholism and substance abuse and mental health

Call this toll-free number 800-698-KIDS (800-698-4543) to get information on this program, or obtain information from the Child Health Plus web site http://www.health.state.ny.us/nysdoh/chplus/cplus-1.htm.

What Is The Benefit?

In general, Medicaid pays for the following services, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements or living arrangements. Please check with your local DSS service Center whose addresses and phone numbers are shown below. Some services have small co-payments.

These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-payment for a service covered in a managed care plan. Types of Medical Services paid for by Medicaid in New York State include:

• Treatment and preventive health and dental care (doctors and dentists)
• Hospital inpatient and outpatient services
• Laboratory and X-ray services
• Care in a nursing home
• Care through home health agencies and personal care
• Treatment in psychiatric hospitals for persons under 21 or those 65 or older
• Treatment in mental health facilities and facilities for persons with developmental disabilities or the mentally retarded
• Family planning services
• Early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
• Medicine, supplies, medical equipment, and appliances (such as wheelchairs, walkers)
• Clinic services
• Transportation to medical appointments, including public transportation and car mileage
• Emergency ambulance transportation to a hospital
• Prenatal care
• Some insurance and Medicare premiums
• Smoking cessation agents

Please note that if you receive both Medicare and Medicaid, you will no longer receive prescription drugs through Medicaid as of January 1, 2006. For further information, please go to our page on Medicare Part D.

If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services. Services must be from Medicaid providers. Not all providers accept Medicaid.

For you to use your Benefit Identification Card for certain medical supplies, equipment, or services (such as wheelchairs, orthopedic shoes, transportation), you or the person or facility that will provide the product or service must receive approval before the product or service can be provided.

When Do the Benefits Apply?

Generally, local districts must determine if you are eligible and send a letter notifying you if your application has been accepted or denied within 45 days of the date of your application. If you are pregnant or applying on behalf of children, the local district has 30 days from the date of your application to determine if you are eligible for Medicaid. If you are applying and have a disability which needs to be evaluated, it can take up to 90 days to determine if you are eligible. You will continue to be eligible as long as you fall within the income and resource guidelines of Medicaid.

How Do I Apply For The Benefit?

• Proof of age, like a birth certificate
• Proof of citizenship or alien status* (see below)
• Recent paycheck stubs (if you are working)
• Proof of your income from sources like Social Security, Supplemental Security Income (SSI), Veteran’s Benefits (VA), retirement
• Any bank books and insurance policies that you may have
• Proof of where you live, like a rent receipt or landlord statement
• Insurance benefit card or the policy (if you have any other health insurance)
• Medicare Benefit Card

If you are dissatisfied with a decision made by Westchester County DSS, you may request a conference with DSS. You may also appeal to the New York State Office of Temporary and Disability Assistance http://www.otda.state.ny.us/oah/forms.asp and request a Fair Hearing.

To apply for a Fair Hearing you should telephone the New York State Office of Temporary and Disability Assistance Fair Hearing Office nearest your home. The New York City office phone number is 800-342-3334. Also, you may write:

Fair Hearing Section
New York State Office of Temporary and Disability Assistance
Office of Administrative Hearing
P.O. Box 1930
Albany, NY 12201
Fax: 518-473-6735

Is There Any Cost To Me?

In some instances there may be a small co-payment.

Who Provides The Benefit?

The Westchester County Department of Social Services manages the Medicaid program.

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