health SPECIAL MEDICARE MEDICAID SECTION Answering your questions about Medicaid How do I apply for Medicaid? You may apply for Medicaid a number of ways, including through the NY State of Health Marketplace (phone 855-355-5777), or through a carrier’s website; a managed care organization; certified application counselors; the Medicaid helpline (800-541-2831) and local Social Services offices. Where you apply for Medicaid will depend on your category. Your category might be single, childless couples, family planning services early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program medicine, supplies, medical equipment, and appliances clinic services transportation to medical appointments, including public transportation and car mileage emergency ambulance transportation to a hospital prenatal care some insurance and Medicare premiums other health services If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services. For you to use your Benefit Identification Card for certain medical supplies, equipment, or services (e.g., wheelchair, orthopedic shoes, transportation), you or the person or facility that will provide the service must Call Humana today 1-855-247-4204 (TTY: 711) Call a licensed sales agent 5 a.m. – 8 p.m., 7 days a week Español? 1-855-247-4209 Y0040_GHHHXDQENI16 Accepted pregnant women, parent(s) and caretaker relatives with dependent children, elderly and/or disabled. The Marketplace determines eligibility using Modified Adjusted Gross Income (MAGI) Rules. In general, income is counted with the same rules as the Internal Revenue Service (IRS) with minor variations. Applications may be completed online, in person with a navigator or certified application counselor, by mail and by phone. The following individuals should apply with New York State of Health Marketplace: adults (not pregnant) aged 19-64, not eligible for Medicare; pregnant women and infants; children ages 1 – 18; and parents and caretaker relatives. What are my rights? The Medicaid application, Access NY Health Care, tells you what your rights are when you apply for Medicaid. See the pages titled “Terms, Rights and Responsibilities.” People who receive Medicaid have privacy rights. Medicaid keeps your health information private and shares it only when we need to. If you are not satisfied with a decision made by the local social services district, you may request a conference with the agency. You may also appeal to the New York State Office of Temporary and Disability Assistance and request a Fair Hearing. What health services are covered by Medicaid? In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan, except for pharmacy services, where a small co-pay will be applied. They include: smoking cessation agents treatment and preventive health and dental care (doctors and dentists) hospital inpatient and outpatient services laboratory and X-ray services care in a nursing home care through home health agencies and personal care treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled (wheelchairs, etc.) Humana has new Medicare health plans. receive approval before the service can be provided (prior approval). Starting January 1, 2014, you can apply for Child Health Plus coverage through the New York State of Health Marketplace: https://nystateofhealth.ny.gov/ Paper, fax, or email applications for Child Health Plus will not be accepted by Child Health Plus Health Plans after December 31, 2013. How do I apply for Child Health Plus? New York State has a health insurance plan for kids, called Child Health Plus. Depending on your family’s income, your child may be eligible to join either Children’s Medicaid or Child Health Plus. Both Children’s Medicaid and Child Health Plus are available through dozens of providers throughout the state. Call this toll-free number: 1-800-698-4KIDS (1-800- 698-4543), and ask about Child Health Plus and Children’s Medicaid. If you are hearing impaired call the TTY number, 1-877-898-5849. From the New York State Department of Health
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