In New York State, if you spend a lot on doctor’s visits, prescriptions, insurance premiums or other healthcare services, but have income over the Medicaid limits, you may still qualify under the Medicaid Spend Down Program (also called the Medicaid Excess Income Program). In other words, you will need to show that you spend enough on health care that it puts your income down below the Medicaid limits.
When you meet your spend down on a monthly basis, you can receive outpatient services within the month you meet it. You can also receive inpatient services if you meet your spend down for six (6) months at a time. You do not need to meet your spend down each month, only the months that you will need it.
There are a number of ways to meet your spend down, such as with unpaid or paid medical bills you have incurred or paying it directly to the Department of Social Services. Any specific questions should be directed to a Medicaid worker. For more information please call 315-366-2211.
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Do you or your family lack health insurance coverage? You may be eligible for medical assistance if you receive public assistance, Supplemental Security Income (SSI), or if you meet income, resource, age or disability criteria. There are special programs to help if you are pregnant or have a child. If you are pregnant, a worker at the clinic or hospital you are using for prenatal care may assist you in applying for Medicaid. If you have a child, he/she may be eligible for children's Medicaid, which provides the same benefits as Medicaid. For more information please call 315-366-2211.
Services available include:
For more information please call 315-366-2211.
Medicaid Managed Care is mandatory in Madison County through Fidelis at 888-343-3547 or United Healthcare at 800-339-5380. Assistance is available through NY Medicaid Choice, Maximus at 800-505-5678.
No interview is necessary. Request an application be mailed to you by calling 315-366-2211. An interview may be scheduled if you would like one. Applications are also available from:
*Medicaid coverage is available, regardless of alien status if you are pregnant or require treatment for an emergency medical condition. A doctor must certify that you are pregnant or had an emergency and you must meet all other eligibility requirements. For more information please call 315-366-2211.
For more information regarding income and resource guidelines for medical assistance programs visit the My Benefits website.
Transitional Medical Assistance is a program that provides continued medical assistance coverage to people who become ineligible for family assistance and who have a dependent child under the age of 21 living with them. Transitional MA benefits are available for 12 months to those who lose family assistance due to:
Medicaid has co-pays for certain services they provide. If you are unable to pay these, your provider can bill you, but you are still responsible for them. Children under 21 and pregnant women (until 60 days postpartum) are exempt from paying co-pays.
The following services are subject to a co-pay:
You are responsible to pay a maximum of up to $200 in a co-pay year. Your year begins on April 1 and ends March 31 each year. If you reach your maximum of $200, a letter will be sent to you exempting you from paying Medicaid co-payments until April 1. For more information please call 315-366-2211.