Medicaid is a public program that provides free or low cost health insurance.
What does Medicaid cover?
You must go to a doctor or facility that accepts Medicaid. Medicaid covers most essential services and treatments that may include:
- All regular medical checkups and follow-up care
- Immunizations
- Doctor and clinic visits
- Prescription drugs
- Medical supplies
- Medical equipment and supplies
- Lab tests and x-rays.
- Eye care and eyeglasses
- Emergency care
- Dental care
- Nursing home care and home care
- Emergency ambulance transportation
- In-patient hospitalization
Types of Medicaid
The Affordable Care Act (2010) created two categories of Medicaid:
- Modified Adjusted Gross Income (MAGI), and
- Non-MAGI which is also known as Aged Blind and Disabled Medicaid (ABD)
Before the Affordable Care Act, there was only the Aged Blind and Disabled Medicaid category. The law grew the Medicaid program and allowed people who did not used to qualify for Medicaid to be able to access free or low cost health insurance.
MAGI Medicaid
Eligibility is based on your household’s modified adjusted gross income.
If you meet the income requirements and meet one or more of these conditions, then you may be eligible for MAGI Medicaid:
- You are pregnant
- You are a child under the age of 19
- You are a parent or relative caring for children under 19
- You are an adult ages 19 through 64 who does not qualify for Medicare
Non-MAGI Medicaid (also known as Aged, Blind and Disabled)
Eligibility is based on your age, disability status, income and resources.
You may be eligible for Non-MAGI Medicaid if you meet the income and resource requirements and you are over 65 years old and/or a person with a disability.
Please note that in New York State, individuals need a disability determination from the Social Security Administration or the State Disability Review Unit if you do not meet the income and resource requirements and need Medicaid due to your disability.
What if I am applying for Medicaid to get OPWDD waiver services?
If you do not already have Medicaid health insurance and you are applying for Medicaid for the purpose of getting services through the OPWDD waiver, it is recommended that you apply for the waiver first before submitting a Medicaid application.
Once you are approved for the waiver, OPWDD will send a letter that you should include with your Medicaid application. Individuals who are under 18 years old and approved for waiver may have their parents income waived. This is called parental deeming.
The Medicaid application should be submitted to your local department of social services (LDSS).
To find your closest LDSS office visit New York State Department of Health’s webpage: New York State Local Departments of Social Services Contact Listings by County
