{"id":61798,"date":"2023-11-30T21:43:01","date_gmt":"2023-12-01T02:43:01","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=61798"},"modified":"2026-01-05T15:14:12","modified_gmt":"2026-01-05T20:14:12","slug":"new-york-medicaid-guide","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/new-york-medicaid-guide\/","title":{"rendered":"Guide to Medicaid in New York"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">New York state has one of the largest populations covered by Medicaid programs, with nearly 6.8 million NY residents receiving benefits as of November 2025, according to the New York State Department of Health. The healthcare program, designed for lower-income and certain disabled New Yorkers, covers people of all ages, but eligibility requirements vary.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Whether you are looking for help with medical care after a job loss or you need additional coverage to help with the birth of a child, the New York Medicaid program may be able to help. Here is what you should know about this coverage option.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Eligibility for Medicaid in New York<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">You may be eligible for healthcare coverage through New York&#8217;s Medicaid program if you meet the specific criteria. Your situation determines if you will apply through the <\/span><a href=\"http:\/\/www.nystateofhealth.ny.gov\/\"><span style=\"font-weight: 400;\">New York State of Health<\/span><\/a><span style=\"font-weight: 400;\"> or your <\/span><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/ldss.htm\"><span style=\"font-weight: 400;\">Local Department of Social Services (LDSS)<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It&#8217;s important to note that eligibility for Medicaid is determined by a holistic assessment of various factors, and age or family living arrangement alone may not be the sole basis for qualification. Additionally, you generally have the flexibility to apply through either method regardless of your circumstances.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Income requirements<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">New York Medicaid uses a household\u2019s <\/span><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/how_do_i_apply.htm\"><span style=\"font-weight: 400;\">Modified Adjusted Gross Income (MAGI)<\/span><\/a><span style=\"font-weight: 400;\"> in determining eligibility. The exact amount you can earn and still qualify changes every year, as it is adjusted to account for inflation.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Resources, such as bank accounts or cars, may be counted in the case of someone who is older than 65, blind, or disabled applying for coverage.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Everyone living in the household will have their income and resources considered when applying.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Applicants will be asked to provide proof of their income and assets, with items such as bank statements, pay stubs, and Social Security award letters, among other forms of documentation.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Age requirements<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Many age groups qualify for Medicaid if their MAGI is below the threshold. These include the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Adults 19-64 years of age who are <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/difference-between-medicare-and-medicaid\/\"><span style=\"font-weight: 400;\">not eligible for Medicare<\/span><\/a><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Children 1-18 years of age<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Infants (younger than 1)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Youth in foster care and former foster care youth<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Children who are not eligible for Medicaid may be able to get coverage through <\/span><a href=\"https:\/\/www.health.ny.gov\/health_care\/child_health_plus\/\"><span style=\"font-weight: 400;\">Child Health Plus<\/span><\/a><span style=\"font-weight: 400;\">, an expanded health insurance program.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Additional coverage may be available for those age 65 and older who are not caregivers.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Disability status<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Some New York residents <\/span><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/publications\/docs\/adm\/04_attac1.pdf\"><span style=\"font-weight: 400;\">may qualify<\/span><\/a><span style=\"font-weight: 400;\"> if they have a disability. The following groups may be covered under \u201cnon-MAGI\u201d eligibility rules:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Residents of group adult homes run by the LDSS and other communities<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Those who are aged, blind, or disabled and don\u2019t qualify by other means<\/span><\/li>\n<\/ul>\n<h3><span style=\"font-weight: 400;\">Citizenship or immigration status<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">New York Medicaid is available to New York residents who are citizens or legal immigrants of the United States. Documentation, including birth certificates, passports, or social security numbers, is usually required to prove eligibility.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">New York Medicaid benefits<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">New York must follow the minimum federal requirements for covered services, but it also covers additional services, too.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Medical services covered<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">New York Medicaid covers medically necessary services, including doctor\u2019s visits, specialist visits, family planning services, hospital services, transportation to medical appointments, X-rays, and diagnostics.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It also covers:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Smoking cessation services and treatments<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Community-based long-term care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nursing home \/ institutional care<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Psychiatric care, including inpatient treatment<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">New York <\/span><a href=\"https:\/\/www.health.ny.gov\/press\/releases\/2023\/2023-08-24_benefits_expansion.htm\"><span style=\"font-weight: 400;\">recently expanded<\/span><\/a><span style=\"font-weight: 400;\"> its coverage with <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/news\/guide-to-medicaid-changes\/\"><span style=\"font-weight: 400;\">Medicaid changes<\/span><\/a><span style=\"font-weight: 400;\"> for pregnant women to include or increase reimbursement rates for the following services:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Doula coverage<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Midwifery services<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Remote patient monitoring<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nutrition counseling<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Lactation counseling<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Expanded prenatal testing services<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Children with Medicaid plans get well-child care visits and childhood immunizations covered, as well.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Prescription drug coverage<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Under the New York State Medicaid Pharmacy program (NYRx), FDA-approved and medically necessary drugs are eligible for coverage. You will need a prescription for anything that&#8217;s not over-the-counter (OTC), and some controlled substances require additional authorization from your provider before they will be covered. It&#8217;s important to note that individuals with both Medicare and Medicaid will obtain their prescriptions via Medicare Part D, not through Medicaid.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Dental coverage<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">New York recently updated dental coverage to provide benefits for basic dental services under <\/span><a href=\"https:\/\/healthfirst.org\/medicaid-managed-care-plan#2023\"><span style=\"font-weight: 400;\">Medicaid<\/span><\/a><span style=\"font-weight: 400;\">. This includes checkups, cleanings, X-rays, and fillings without a referral from a primary care healthcare provider.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Vision coverage<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Vision care, including eye exams and prescription eyeglasses, is covered by Medicaid in New York. Depending on your plan, you may get access to additional services.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Long-term care coverage<\/span><\/h3>\n<p><a href=\"https:\/\/assets.healthfirst.org\/pdf_b4b43bcca8\"><span style=\"font-weight: 400;\">Medicaid-managed care plans<\/span><\/a><span style=\"font-weight: 400;\"> may pay for medically necessary long-term care, including nursing homes with 24\/7 medical care, therapy, and assistance with daily activities. The long-term care must be ordered by a healthcare provider and approved by your Medicaid-managed care plan. Income and assets may be a factor in determining how much a patient will put toward the costs.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Mental health and substance abuse coverage<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">New York Medicaid covers the <\/span><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/members\/faqs_benefits.htm\"><span style=\"font-weight: 400;\">following services<\/span><\/a><span style=\"font-weight: 400;\">:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Treatment in psychiatric hospitals<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Services provided in mental health facilities<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Services from the Office of Mental Health (OMH)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/redesign\/mrt2\/pharmacy_transition\/mat.htm\"><span style=\"font-weight: 400;\">Medication-assisted treatment facility services<\/span><\/a><span style=\"font-weight: 400;\"> (MAT)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Additional mental health or drug abuse treatment services may be covered. Contact the facility to see if they accept Medicaid before making an appointment.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Medicaid Excess Income in New York<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Even if you make more money than the state\u2019s guidelines, you may still be eligible for the <\/span><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/excess_income.htm\"><span style=\"font-weight: 400;\">Medical Excess Income (&#8220;Spenddown&#8221; or &#8220;Surplus Income&#8221;) Program<\/span><\/a><span style=\"font-weight: 400;\">. This helps you with medical bills after you pay a portion of the amount, with the full amount you pay dependent on your income.<\/span> <span style=\"font-weight: 400;\">The program covers you for one month or three months at a time, depending on the help needed. It may also pay medical bills from the three months prior to getting coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You must be under age 21, age 65 or older, certified blind or certified disabled, pregnant, or a parent of a child under age 21 to qualify for the Excess Income program. If you do qualify, you will apply through the LDSS.\u00a0<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Medicaid Managed Care in New York<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">New York Medicaid contracts with private health insurers in the state to deliver insurance coverage services, but the companies and plan types vary by county. Use the <\/span><a href=\"https:\/\/info.nystateofhealth.ny.gov\/plans-by-county\"><span style=\"font-weight: 400;\">plan finder tool<\/span><\/a><span style=\"font-weight: 400;\"> to see what options exist where you live.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">How to apply for New York Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Applications for Medicaid can happen at any time, and you don\u2019t have to wait for <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/aca-open-enrollment\/\"><span style=\"font-weight: 400;\">ACA open enrollment<\/span><\/a><span style=\"font-weight: 400;\"> to get started.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">You can also call and speak to the Marketplace Customer Service Center at (855)355-5777 or the Medicaid Helpline at (800)541-2831.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Required documents for application<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The exact paperwork you need depends on the program you are applying for. MAGI-based programs will ask for the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Household income for the upcoming year<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Citizenship or immigration status and documentation<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Social Security Number<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Non-MAGI programs will ask for the following:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Social Security Number for U.S.-born citizens or a Naturalization Certificate for naturalized citizens<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Proof of immigration or citizenship status<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Proof of age\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Four weeks of recent paychecks or income from Social Security, Veteran\u2019s Benefits, Child Support, or Unemployment Benefits<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Bank statements and other proof of assets (if applying for nursing home care and over 65 years of age or certified blind or disabled)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Proof of residency, such as a rent receipt or mortgage statement<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Proof of any current insurance coverage (Medicare or other health insurance policy)<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">You may also be asked to show proof that you applied for Medicare if you are 65 years or older.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The state of New York may ask for clarifying information in addition to these items at any time during your application process.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">New work requirements<\/span><\/p>\n<p><span style=\"font-weight: 400;\">As a result of legislation enacted in the summer of 2025, some Medicaid recipients will need to prove that they are working or volunteering in order to receive coverage. <\/span><span style=\"font-weight: 400;\">The new requirement applies to certain low-income childless adults between 18 and 64 without disabilities, and certain parents of older teenagers. With some exceptions for people with substance use disorders, disability, or those who are caring for a sick relative, these individuals will likely need to show that they worked or volunteered at least 80 hours monthly in order to continue receiving benefits. This process is likely to start in January 2027.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Online application process<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The best way to apply for Medicaid is through an online application. This will get you the quickest response and can help you track your submission.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">Paper application process<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Those applying for non-MAGI coverage, such as those blind, disabled, or over age 65, send in a <\/span><a href=\"https:\/\/www.health.ny.gov\/forms\/doh-4220.pdf\"><span style=\"font-weight: 400;\">paper application<\/span><\/a><span style=\"font-weight: 400;\">. Note that you can still call and ask for help with the application, and blind applicants may be able to get assistance with a large-print application. You can also bring the paper to a <\/span><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/ldss.htm\"><span style=\"font-weight: 400;\">local office<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">Cost of New York Medicaid<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you qualify for Medicaid coverage, there is <\/span><a href=\"https:\/\/info.nystateofhealth.ny.gov\/Medicaid\"><span style=\"font-weight: 400;\">no monthly premium<\/span><\/a><span style=\"font-weight: 400;\"> to pay. You may have to pay a small copay at the time of service, depending on your financial situation. Those who don&#8217;t qualify for standard New York Medicaid but get coverage through the Spenddown program will have to pay until they meet their excess income amount and then will have help paying the rest of their bills.<\/span><\/p>\n<p><a href=\"https:\/\/info.nystateofhealth.ny.gov\/Medicaid\"><span style=\"font-weight: 400;\">Medicaid Information | NY State of Health<\/span><\/a><\/p>\n<h2><span style=\"font-weight: 400;\">Additional New York Medicaid resources<\/span><\/h2>\n<p>The best way to learn about New York Medicaid is by visiting the following sites:<\/p>\n<ul>\n<li aria-level=\"1\"><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/\">New York State of Health Medicaid Information<\/a><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><a href=\"https:\/\/nystateofhealth.ny.gov\/\">New York Health Insurance Marketplace<\/a><\/li>\n<\/ul>\n<ul>\n<li aria-level=\"1\"><a href=\"https:\/\/www.health.ny.gov\/health_care\/medicaid\/program\/contact.htm\">Important Medicaid Phone Numbers<\/a><\/li>\n<\/ul>\n<h2><span style=\"font-weight: 400;\">New York Medicaid FAQ<\/span><\/h2>\n<h3><span style=\"font-weight: 400;\">How do you find a doctor who accepts Medicaid?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">The best way to find out if your current healthcare provider or facility accepts Medicaid is to ask before you receive services since their insurance agreements may change. You can also use <\/span><a href=\"https:\/\/pndslookup.health.ny.gov\/facility\/health_plan\"><span style=\"font-weight: 400;\">the New York provider website<\/span><\/a><span style=\"font-weight: 400;\"> to search by your type of Medicaid plan and the facility or provider you like best. It will provide a list of options for new doctors or hospitals if you don&#8217;t already have one.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">How to renew Medicaid coverage?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">As long as you don&#8217;t have a lapse in coverage, you don&#8217;t have to reapply every year for Medicaid. You will be given a chance to update your information every 12 months as part of a renewal process. If you haven\u2019t updated your contact information, such as address and phone number, since you applied, you will want to do that when you renew. If you remain eligible, you will continue to be covered.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you are required to provide proof of work or volunteerism due to the new work requirements, you may be asked to provide documentation twice a year or more. New York is in the process of developing their process for meeting this requirement, which starts in 2027.<\/span><\/p>\n<h3><span style=\"font-weight: 400;\">How to report Medicaid fraud?<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">If you believe your healthcare provider, a service provider, or someone you know is committing fraud or using their Medicaid card in a way they shouldn\u2019t, you can contact the Medicaid Fraud Hotline at 1-877-87 FRAUD (1-877-873-7283).<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>New York state has one of the largest populations covered by Medicaid programs, with nearly 6.8 million NY residents receiving benefits as of November 2025, according to the New York State Department of Health. The healthcare program, designed for lower-income and certain disabled New Yorkers, covers people of all ages, but eligibility requirements vary. Whether [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":61799,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[16],"coauthors":[8861],"class_list":["post-61798","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicaid","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Guide to Medicaid in New York | SingleCare<\/title>\n<meta name=\"description\" content=\"Everything you need to know to receive free or low-cost health services from New York Medicaid, including how to apply, eligibility, restrictions, coverage, and more.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link 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