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Applying for Medicaid

Consumer Directed Personal Assistance (CDPA) is a state Medicaid program.

Medicaid provides health coverage for people who are low income and people who have been certified blind or disabled by the state. Medicaid is also available for children, pregnant women, single adults and families. Being Medicaid eligible does not mean you automatically qualify for CDPA, but you cannot receive CDPA services from the state without Medicaid. 

New York Health Access has produced an EXCELLENT resource about using Medicaid to get health care. We strongly recommend reading it!

Ways to apply for Medicaid:

New York State of Health

The most straightforward is probably contacting the NY State of Health: The Official HealthPlan Marketplace. The Marketplace will provide you with a free enrollment assister to help you apply. If you find it difficult to navigate their website you may also call the Marketplace Customer Service Center at (855) 355-5777 (TTY: 1-800-662-1220). Be prepared to answer detailed questions about income and disability status. 

Your Managed Care Organization

If you are already part of a Managed Care Organization, they may be able to assist you in applying for Medicaid.

Your Local Department of Social Services

If you do not qualify for Managed Care, you may apply through your local department of social services.They can also assist you with certifying (for state purposes) that you are disabled.

In New York City, the local department of social services is named the Human Resources Administration (HRA).

The Medicaid Helpline

There is also a Medicaid Helpline to answer questions at (800) 541-2831.

Qualifying for Medicaid despite exceeding Medicaid income limits

Even if you do not meet New York’s income limit for Medicaid, you may still be able to access CDPA and other Medicaid long term services. There are three ways to qualify for Medicaid for people who have more income or assets than the Medicaid income limit:

  • A Supplemental Needs Pooled Trust allows you to qualify by paying excess income into a pooled trust. Medicaid will then cover your health care while the trust will pay for most other expenses (provided there are sufficient funds). Pooled trusts can often help people avoid having to choose between qualifying for health care and covering their other bills. New York Health Access offers an excellent resource on how to enroll in a trust.
  • Using the amount of excess income to pay for medical expenses. 
  • Paying down excess income to your LDSS. This is called a “spend down.”

For more information about Medicaid applications and Eligibility, the NY State Department of Health has resources on their website. 

Types of Medicaid Managed Care Plans

Only some plans cover long-term care services:

People who have Medicaid only:

  • Mainstream Managed Care
  • Health and Recovery Plans (HARPs)
  • HIV Special Needs Plans (SNP)

People who have Medicare and Medicaid:

  • Managed Long Term Care (MLTC)
  • Medicaid Advantage Plus (MAP)
  • Program for All-Inclusive Care for the Elderly (PACE)
  • Fully Integrated Dual Advantage (FIDA)
  • FIDA-IDD

Waivers:

  • Nursing Home Transition & Diversion (NHTD) Waiver 
  • Traumatic Brain Injury (TBI) Waiver