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www.LawNY.org What is Medicaid? Medicaid is a program that pays for medical care for eligible people who cannot afford it.
How do I know if I qualify for Medicaid? Medicaid only covers people who are financially needy. There are three main groups that Medicaid pays for:
- Families with children under 21 or pregnant women
- The aged, blind, or disabled
- Single people or couples without children
This chart shows how much income you can have every month and how many resources you can own and still be financially eligible for Medicaid:
2008 Income & Resource Levels | Number in Family | Monthly Net Income | Resources | 1 | $725 | $4350 | 2 | $1067 | $6400 | 3 | $1100 | $6600 | 4 | $1109 | $6650 | 5 | $1117 | $6700 | 6 | $1134 | $6800 | 7 | $1275 | $7650 | 8 | $1417 | $8500 | For each additional person, add: | $142 | $850 |
Courtesy of New York State Department of Health Please remember that these numbers can be changed every year. For an up-to-date chart, click here.
You can also own a house or car and still be eligible. The income and resources of every adult in the house will be counted towards the total.
If I make more money than the chart shows, can I still get Medicaid? Some people can. Pregnant women and children can have higher incomes and no resource limits. For a chart showing income limits for pregnant women and children please click here. If you make too much money, you may be able to do what is called a spenddown to qualify for Medicaid.
What is a spenddown? If you make too much money to qualify for Medicaid, you still might be able to get Medicaid if you spend the excess money on medical bills. This is called a spenddown.
For example, a person over 65 is denied Medicaid because her monthly income is $50 more than the limit for Medicaid eligibility. If she spends that $50 on medical bills every month, Medicaid will cover the rest of her medical bills.
Am I qualified for a spenddown? Not everyone qualifies for a spenddown. To qualify, you must be in one of the following groups:
- under 21
- over 65
- blind or disabled
- in a family where one or both of the parents is absent, dead, disabled, or out of work
If you have been denied full Medicaid coverage, the notice DSS sends you should tell you if you qualify for a spenddown, and how much it would be.
What type of medical bills count towards a spenddown? Many different types of medical bills can count towards a spenddown, including your own bills, your spouse’s, your child’s (or a child you care for), past unpaid bills, and any part of a medical bill not covered by Medicare or other insurance.
Certain medical expenses can count towards your spenddown as well, such as transportation expenses to get medical care, prescription drug bills, and payments to drug or alcohol programs, therapists, and doctor-ordered medical equipment such as hearing aids and eyeglasses.
If I cannot get Medicaid, are there any other health assistance programs I might qualify for? Adults who do not qualify for Medicaid may qualify for Family Health Plus. For information on Family Health Plus, click here.
Households with children who do not qualify for Medicaid may be able to get care for the children under the Child Health Plus program. For more information, see the article entitled "Child Health Plus" on our website.
How do I apply for Medicaid? To apply for Medicaid you can write, call, or go to your local Department of Social Services (DSS). For a list of DSS offices in every county, click here. Your DSS office will also be able to tell you where else you might be able to apply, such as some hospitals or health clinics.
Generally, you will be sent a letter within 45 days of your application notifying you if your application has been accepted or denied. If you are pregnant or are applying for a child, you should get a reply within 30 days. If you have a disability, it may take 90 days to get a reply.
What happens if my application for Medicaid is denied? If your application is denied, you have the right to request a Fair Hearing. You can request a hearing by mail, telephone, fax or online. You can mail your request to:
New York State Office of Temporary and Disability Assistance Office of Administrative Hearings
P.O. Box 1930
Albany, NY 12201-1930
You can fax your request to (518) 473-6735.
You can call (800) 342-3334.
You can complete the form online at: http://www.otda.state.ny.us/oah/forms.asp.
For more information, please see the article on our website entitled "Fair Hearings."
If I lose my job will I lose Medicaid? No, you cannot be denied or lose Medicaid if you lose your job.
Does Medicaid have any time limit? No.
Please make sure that your doctor accepts Medicaid payments. * * * * * Legal Assistance of Western New York, Inc. This article provides general information about this subject. Laws affecting this subject may have changed since this article was written. For specific legal advice about a problem you are having, get the advice of a lawyer. Receiving this information does not make you a client of our office.
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