New York Medicaid
Updated April 8, 2021 Medicaid
New York Medicaid is a program for New Yorkers who can't afford to pay for medical care. Medicaid pays for a number of services, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small copayments.
| Program Name | New York Medicaid |
| Expanded Medicaid | Yes |
| Website | health.ny.gov/health_care/medicaid |
| [email protected] | |
| Phone | 800–541–2831 |
| Apply Online | https://nystateofhealth.ny.gov/ |
| Appeal a Denial | https://otda.ny.gov/hearings/request/ |
| Find a Local Office | Local Departments of Social Services |
Eligibility Requirements
To be eligible for New York Medicaid, you must be a resident of the state of New York, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.
You must also be one of the following:*
- Pregnant
- Be responsible for a child 18 years of age or younger
- Blind
- Have a disability or a family member in your household with a disability
- Be 65 years of age or older
* ACA Medicaid expansion covers eligible low-income adults.
Annual Household Income Limits (before taxes)
| Household Size* | Maximum Income Level (Per Year) |
| 1 | $17,131 |
| 2 | $23,169 |
| 3 | $29,207 |
| 4 | $35,245 |
| 5 | $41,284 |
| 6 | $47,322 |
| 7 | $53,360 |
| 8 | $59,398 |
*For households with more than eight people, add $6,038 per additional person.
Available Services Include:
| Ambulance services | Lab tests and X-rays |
| Clinic visits | Medical equipment |
| Dental care | Mental health services |
| Doctor visits | Nursing home care |
| Eye care and eye glasses | Prenatal care |
| Family planning services | Prescriptions |
| Hospital services | Smoking cessation agents |
| Immunizations | Transportation to medical appointments |
Copayments
The following services are subject to a copayment in New York:
| Clinic Visits | $3.00 |
| Medical Supplies | $1.00 per claim |
| Inpatient hospital stays | $25.00 |
| Emergency room for non-emergencies | $3.00 |
| Pharmacy (brand name preferred) | $1.00 |
| Pharmacy (brand name non-preferred) | $3.00 |
| Pharmacy (generic) | $1.00 |
| Non-prescription drugs (over the counter) | $0.50 |
The following are exempt from all New York Medicaid copayments:
- Private practicing physician services
- Laboratory and X-ray services
- Home health services
- Long term home health care services
- Family planning services
- Children under 21
- Pregnant women
- Residents of a licensed nursing home
- Residents of a licensed mental health facility.
- Enrollees in a Comprehensive Medical Case Management (CMCM) or Services Coordination Program.
- Enrollees in Traumatic Brain Injury (TBI) waiver programs
- Psychotropic and tuberculosis drugs.
- Members with incomes below 100% of the federal poverty level
- Members in hospice
- Most American Indians and Alaska Natives
Copay Maximum
You are responsible to pay a maximum of up to $200 in a copay year. Your year begins on April 1st and ends on March 31st each year. If you reach your maximum of $200, a letter will be sent to you exempting you from paying Medicaid copayments until April 1st.
