Medicaid

New York State Medicaid program is administered and funded by New York State and the federal government.   You can apply through the New York State of Health Marketplace or locally through the Dutchess County Department of Community and Family Services.

Apply in the New York State of Health Marketplace if you are:

• Age 19 – 64 (not pregnant), not eligible for Medicare
• Applying for children ages 0 – 18
• Parents or caretaker relatives of a child

Apply through the Dutchess County Department of Community & Family Services if you are:

• Age 65 and older (not parents or caretaker relatives)
• Enrolled in Medicaid Buy-In for Working People with Disabilities enrollees
• Former foster care youth
• Resident of adult homes and nursing homes
• Resident of treatment center/community residences operated by the Office of Mental Health (OMH) 
• Applying for AIDS Health Insurance Program (AHIP) or Medicaid Cancer Treatment Program
• Applying for Medicare Savings Program (MSP)
• Your eligibility is based on being blind or disabled or you request coverage for community based long term care (CBLTC) services; including those individuals with an immediate need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS)

How do I apply?

Applications can be found online on the NYS Department of Health website by clicking links below:

• Medicaid Application Packet
  • Access NY Application (.pdf)
  • Supplement A (DOH-5178A) (.pdf)
  • Submission of Application on Behalf of Application (DOH-5147) (.pdf)
  • Authorization for Verification of Resources- Applicant (DOH-5148) (.pdf)
  • Authorization for Verification of Resources – Legal Spouse (DOH-5149) (.pdf)
  • Accessing Applicant/Recipient Informational Book (LDSS-5084) (.pdf)
  • Optional Pay-In Program for Individuals with Excess Income (OHIP-4548) (.pdf)
  • Explanation of the Excess Resource Program (OHIP-0102) (.pdf)
  • Medicaid Pharmacy Program (.pdf)
  • Immediate Need Paperwork:
    • DOH 5786 Immediate Need for Personal Care/Consumer Directed Personal Assistance Services (ny.gov) (.pdf)
    • DOH 5779 Practitioner Statement of Need for Personal Care/Consumer Directed Personal Assistance Services (ny.gov) (.pdf)
    • Medicare Savings Program (MSP) (ny.gov)

If you apply at one of our Department of Community and Family Services locations, you will need the following documents:

• If you are a U.S. citizen (born in the U.S. or one of its territories) and provide a valid Social Security Number (SSN), a match with the Social Security Administration (SSA) will verify your SSN, date of birth, and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need to submit proof of naturalization (e.g., Naturalization Certificate (N-550 or N-570) or a U.S. passport. 
• Proof of citizenship or immigration status (non-USA citizens).
• Proof of age (if not verified by SSA), like a birth certificate.
• Last four weeks of paycheck stubs (if you are working).
• Proof of all your gross income; including sources like Social Security, Veteran’s Benefits (VA), retirement benefits, Unemployment Insurance Benefits (UIB), Child Support payments, IRA and Annuity distributions.
• IRA and annuity account information, including current balance
• Complete copy of all trusts, including current Schedule A.
• If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information of all bank accounts, insurance policies and all other resources.
• Proof of where you live, such as a rent receipt, landlord statement, mortgage statement, current utility bill or envelope from mail you received recently.
• Copy (front and back) of insurance benefit cards (if you have any other health insurance).
• Copy of Medicare Benefit Card (the red, white, and blue card).

Note: Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition and you meet all other Medicaid eligibility requirements. 

Consents:

​​DOH-5247_102017 (.pdf) - Medicaid Authorized Representative Designation/Change Request

To learn more

• NY State of Health, The Official Health Plan Marketplace
• Managed Care Organization (MCO)
• Medicaid Helpline 800-541-2831
• Health Insurance Programs - New York State Department of Health (ny.gov)