Frequently Asked Questions

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:

• Child teen/health program
• Clinic services
• Dental care (treatment and preventative services)
• Domiciliary care facilities
• Drugs (prescription and non-prescription) and smoking cessation products
• Eyeglasses
• Family planning
• Health insurance and Medicare premium payments
• Inpatient and outpatient care in hospitals
• Laboratory and X-ray services
• Medical equipment (wheelchairs, walkers, etc.)
• Nursing home care
• Personal care/long term home health care
• Physician services
• Prenatal care
• Psychiatric hospitalization and mental health services
• Transportation to medical appointments
• Treatment in facilities for the mentally retarded and developmentally disabled

For more information, please call 315-366-2211.

Medicaid Managed Care enrollment is mandatory in Madison County. Coverage is available through Fidelis Care at 888-343-3547 or UnitedHealthcare at 800-339-5380.

Enrollment assistance is available through NY Medicaid Choice (Maximus) at 800-505-5678.

No interview is required. You may request that an application be mailed to you by calling 315-366-2211. An interview can be scheduled if you would like one. Applications are also available from the following organizations:

• Madison County Office for the Aging, Inc.: 315-697-5700 (MSP application)
• Maternal Child Care Health Center: 315-366-2361
• Mohawk Valley Perinatal Network: 877-267-6193 or 315-732-465

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

*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 (TMA) is a program that provides continued medical coverage for individuals who become ineligible for Family Assistance and who have a dependent child under age 21 living in the household.

Transitional Medical Assistance coverage is available for up to 12 months for individuals who lose Family Assistance due to:

• Increased earned income
• Loss of earned income disregards
• New employment

For more information, please call 315-366-2211.

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.

Medicaid requires co-payments for certain services. If you are unable to pay a co-pay at the time of service, your provider may bill you, and you remain responsible for payment. Children under age 21 and pregnant individuals (through 60 days postpartum) are exempt from Medicaid co-payments.

The following services are subject to a Medicaid co-pay:

• Clinic visits (hospital-based and free-standing Article 28 Health Department–certified facilities): $3
• Laboratory tests performed by an independent clinical laboratory or any hospital-based or free-standing clinic laboratory: $1 per procedure
• X-rays: $1 per procedure
• Medical supplies: $1 per claim (includes syringes, bandages, gloves, sterile irrigation solutions, incontinence pads, ostomy bags, heating pads, hearing aid batteries, nutritional supplements, and similar items)
• Inpatient hospital stays (one or more overnight stays; due upon discharge): $25
• Emergency room visits for non-urgent or non-emergency services: $3 per visit
• Prescription drugs:
  • $3 – brand name, non-preferred
  • $1 – brand name, preferred
  • $1 – brand name when less than the generic
  • $1 – generic
• Non-prescription (over-the-counter) drugs: $0.50

Co-Pay Maximum

Medicaid limits the total amount you are required to pay in co-pays to $200 per co-pay year. The co-pay year runs from April 1 through March 31.

Once you reach the $200 maximum, you will receive a letter confirming that you are exempt from additional Medicaid co-payments until the start of the next co-pay year on April 1.

For more information, please call 315-366-2211.