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Medical Assistance, Medical Services and Managed Care/SSI

Who is eligible for MEDICAID?
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 can assist you to apply for Medicaid. If you have a child, he/she may be eligible for Medicaid, but if Medicaid ineligible may qualify for the NEW YORK STATE CHILD HEALTH PLUS PROGRAM..

What Medical Services are paid for by Medicaid in New York State?

  • inpatient care in hospitals
  • outpatient care at hospitals
  • physician services
  • clinic services
  • dental care
  • drugs (prescription and non-prescription)
  • eyeglasses
  • nursing home care
  • personal care/long term home health care
  • domiciliary care facilities
  • child teen/health program
  • managed care
  • prenatal care
  • family planning
  • laboratory and X-ray services
  • mental health services
  • health insurance and Medicare premium payments

How can I apply for Medical Assistance or for Child Health Plus?
The application and instructions are available online:
Medicaid and Child Health Plus Application with instructions

Applications for Medical Assistance are available and can be filed at the Social Services Main Office, 797 Broadway, Schenectady, NY, 12305.

Applications may also be mailed to the Social Services Main Office at 797 Broadway, Schenectady, New York 12305.

For your convenience, applications for Medicaid and Child Health Plus can be filed at several community based organizations or with one of the following facilitated enrollment groups which have sites throughout Schenectady County:

  • St. Clare's Family Health Center
  • Schenectady Community Health Center
  • Schenectady County Adult Protective Services
  • Planned Parenthood Clinics
  • Healthy Capital District Initiative (HCDI) - 518-462-7040
  • Fidelis Care - 518-427-0481
  • Catholic Charities - 518-374-5667
  • Capital District Physician's Health Plan

Schenectady County Department of Social Services has a deputized worker program for Ellis Hospital and Albany Medical Center. This program allows people who are hospitalized to apply for Medicaid at that facility.

What is Transitional Medical Assistance?
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 six months to those who lose family assistance due to:

  • new employment
  • increased earned income
  • loss of earned income disregards

An additional six months, up to a total year, may be possible if the person remains employed; has earned income below certain levels; and has a dependent child under the age of 21 living with them.

New York State provides continued Medicaid coverage for children in foster care. A child who was in foster care on or after his/her 18th birthday will continue to receive Medicaid upon final discharge from foster care without regard to his/her income or resources up to age 21. The child must continue to be a New York State resident to have his/her Medicaid continued.

What if I don't qualify for Medical Assistance but I have no health insurance?
New York State has health insurance programs for all uninsured children up to 19 years of age and some uninsured adults. Children ineligible for Medicaid may receive health services under Child Health Plus available through providers throughout Schenectady.

What services are covered by Child Health Plus?

  • well-child care
  • physical examinations
  • immunizations
  • diagnosis and treatment of illness and injury
  • X-rays and lab tests
  • outpatient surgery
  • emergency care
  • prescription drugs
  • inpatient hospital medical or surgical care
  • short-term therapeutic outpatient services (chemotherapy, hemodialysis)
  • limited outpatient treatment for alcoholism, substance abuse, and mental health

How can I apply for my child?
Call 1-800-698-KIDS (1-800-698-4543) or you can obtain information from the Child Health Plus website.

What is Family Health Plus?
Family Health Plus provides coverage to adults who do not have health insurance but have income too high for Medicaid. Parents and childless adults aged 19 through 64 are eligible if they live in New York State, have no health insurance and meet income guidelines. There is no cost to participate in Family Health Plus. Health care is provided through managed care plans. Family Health Plus will do its best to help participants continue to see their current doctor.

What services are covered by Family Health Plus?

  • physician services
  • inpatient and outpatient health care
  • prescription drugs and smoking cessation products
  • X-rays and lab tests
  • vision, speech, and hearing services
  • rehabilitative services (some limits apply)
  • durable medical equipment
  • inpatient hospital medical or surgical care
  • emergency room and emergency ambulance
  • drug, alcohol, and mental health treatment (some limits apply)
  • diabetic supplies and equipment
  • radiation therapy, chemotherapy and hemodialysis
  • dental services (if offered by the plan)

How can I enroll in Family Health Plus?
Enrollment facilitators and social service district offices answer questions and help you choose a health plan. Call 1-877-9FHPLUS (1-877-934-7587) or visit the Family Health Plus website.

Family Health Plus -Premium Assistance Program
The FHPlus Premium Assistance program will pay the subscriber portion of the employer sponsored health insurance premium. The program also pays deductibles and co-payments.
What is the Medicare Savings Program?
Medicaid is available for low income persons seeking assistance with paying their Medicare Part B Premium. The application is available on-line: Medicare Saving Program Application

For information contact the Health Insurance Counseling and Assistance Program (HICAAP) Coordinator at (518) 372-5667

What is the Medicaid Buy-In Program for Working People with Disabilities?
The program provides Medicaid coverage for persons 16-64 years of age, who are certified disabled by the Social Security Administration and engaged in a work activity for which they receive financial compensation. The individual's total net income must be at or below 250% of the federal poverty level.

What is Supplemental Security Income (SSI)?
Supplemental Security Income (SSI) is a federal assistance program for the aged (65 and over), blind and disabled which is administered through local Social Security Offices. SSI beneficiaries are automatically eligible for Medicaid and may be eligible for Food Stamps and Emergency Assistance to Adults (EAA), as well as other services, through the local district offices. A small number of SSI recipients, whose available income is less than the applicable public assistance standard, may be eligible for Safety Net Assistance. Any public assistance applicant who reasonably appears to qualify for SSI, must apply for SSI and appeal any negative determination made by the Social Security Administration.

What is SSI Disability Review?
SSI Disability Review seeks to assist disabled individuals to secure Federal SSI benefits. Retro Review seeks to evaluate Medicaid cases with high expenditures against Federal disability criteria to secure Federal participation and reimbursement.

Address questions about individual SSI claims to the Social Security Administration at 1-800-772-1213; Visit the Social Security website for information.


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Contact Information

Dennis J. Packard
Commissioner

797 Broadway
Schenectady, New York  12305-2704
Ph: 518-388-4470
Fax: 518-388-4644


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