New York Medicaid Office

New York Medicaid offices (DOH, Marketplace, LDSS, HRA)

New York Medicaid is administered by the New York State Department of Health (DOH). The program covers more than 7.5 million New Yorkers as of December 2023, and reaches members through three application pathways: the NY State of Health marketplace, county Local Departments of Social Services (LDSS), and — in New York City — the Human Resources Administration (HRA). DOH sets policy and rates; counties and the Marketplace handle eligibility.

How to reach New York Medicaid

• Medicaid Helpline (statewide) — (800) 541-2831. Mon–Fri 8 a.m.–8 p.m., Sat 9 a.m.–1 p.m.
• NY State of Health Marketplace — (855) 355-5777. TTY: 1-800-662-1220. Use this line for MAGI Medicaid, dual-eligible enrollment, and Marketplace Customer Service.
• New York City — HRA Medicaid Helpline — (888) 692-6116. HRA Infoline: (718) 557-1399.
• Local Department of Social Services (LDSS) — for non-MAGI Medicaid, the Spenddown program, community-based long-term care, and SSI-related cases outside NYC. County-specific contacts are listed at health.ny.gov/health_care/medicaid/ldss.htm.
• Fair hearings — LDSS/HRA decisions: (800) 342-3334. Marketplace decisions: (855) 355-5777.
• Report Medicaid fraud — Office of the Medicaid Inspector General (OMIG): 1-877-873-7283.
• 1095-B tax form requests — (800) 541-2831 or 1095B@health.ny.gov.

NYS Department of Health mailing address: Empire State Plaza, Corning Tower, Albany, NY 12237. Marketplace mailing address: NY State of Health, P.O. Box 11774, Albany, NY 12211. Where you apply depends on your category — see the eligibility and apply sections below.

Who qualifies for New York Medicaid?

New York fully expanded Medicaid under the Affordable Care Act. Adults 19–64 can qualify based on income alone, without a disability or dependent children. Most working-age applicants use modified adjusted gross income (MAGI) rules and apply through the NY State of Health marketplace.

MAGI Medicaid eligibility groups

• Adults 19–64 not eligible for Medicare
• Children ages 1–18 — at 154% FPL
• Infants under age 1 — at 223% FPL
• Pregnant individuals — at 223% FPL; coverage continues for 12 months postpartum
• Parents and caretaker relatives of any age, including those who also have Medicare

Non-MAGI Medicaid eligibility groups

Non-MAGI rules apply to older adults, people with disabilities, and certain specialty programs. As part of DOH's multi-year modernization, many non-MAGI applicants now apply through NY State of Health. Some non-MAGI groups still apply through LDSS:

• Dual-eligible (Medicaid + Medicare) — through NY State of Health
• Adults 65+ not seeking long-term care services — through NY State of Health
• Medicare Savings Program applicants — through NY State of Health
• Blind or disabled adults not in a MAGI group — through LDSS
• People needing Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS) — through LDSS
• SSI recipients — through LDSS
• Community-based long-term care applicants — through LDSS
• Medicaid Excess Income (Spenddown) Program — through LDSS
• Adult Home residents, OMH/OPWDD Community Residence residents — through LDSS
• COBRA, AIDS Health Insurance Program (AHIP), Medicaid Buy-In for Working People with Disabilities — through LDSS
• Foster care and former foster care youth (eligible through age 26) — through LDSS

Medicaid Buy-In for Working People with Disabilities

A working person with a disability in New York State in 2026 can earn up to $68,654 in income before losing Medicaid coverage. Members pay a small monthly premium based on income.

Estate recovery

Medicaid may recover the cost of services from the estate of a member who received services on or after age 55 or while permanently residing in a medical institution. For MAGI-group members, recovery is limited to nursing facility, home and community-based services (HCBS), and related hospital and prescription drug services.

Medicaid rules are changing

Starting January 1, 2027, some New York Medicaid members will need to show they are working, going to school, helping out in the community, or participating in job training to keep coverage. DOH publishes updates at info.nystateofhealth.ny.gov/stay-covered.

New York Medicaid income limits

New York Medicaid income limits depend on which group applies. MAGI applicants use rules aligned with IRS modified adjusted gross income. Non-MAGI applicants (aged, blind, disabled, long-term care) use the chart DOH publishes annually each January, paired with a resource limit. The figures below are effective January 1, 2025 — verify the current chart before relying on a specific number.

Non-MAGI income and resource limits (effective January 1, 2025)

You may own a home, a car, and personal property and still qualify. Income and resources of legally responsible relatives in the household are counted.

Expanded income for children and pregnant individuals

Children whose family income is above the Medicaid limit may qualify for Child Health Plus.

Medicaid Excess Income (Spenddown) Program

New Yorkers whose income exceeds the Medicaid limit can still qualify under the Excess Income Program — sometimes called Spenddown or Surplus Income. Eligible groups: under 21, age 65+, certified blind or disabled, pregnant, or a parent of a child under 21. The LDSS caseworker calculates the difference between your countable income and the Medicaid limit. Two pathways:

• Outpatient spenddown (one month at a time) — submit medical bills equal to or greater than your excess income to LDSS. Coverage activates for that month.
• Inpatient/hospital spenddown (six months) — submit bills (paid or unpaid) equal to your excess income for six months. Once met, receive six months of Medicaid coverage including inpatient.
• Pay-In Program — pay your excess-income amount directly to LDSS if you don't have bills but need care that month.

Bills that count: doctor, dental, clinic, eye exam, lab, prescription drugs, transportation, therapists, home health aides, co-pays and deductibles for Medicare or private insurance, durable medical equipment, hearing aids, eyeglasses, and bills paid by EPIC or ADAP. Past paid bills (within three months of application) can be used for up to six months; past unpaid bills can be used indefinitely while still legally collectible.

How to apply for New York Medicaid

Where you apply for New York Medicaid depends on your eligibility category. Most MAGI applicants and a growing share of non-MAGI applicants use the NY State of Health marketplace. Others apply through a Local Department of Social Services (LDSS), or in New York City through the Human Resources Administration (HRA).

Apply through NY State of Health (Marketplace)

nystateofhealth.ny.gov is the state's official health-plan marketplace. Free help is available from Enrollment Assistors. Customer service: (855) 355-5777 (TTY: 1-800-662-1220).

Use NY State of Health if you are:

• Age 19–64 and not eligible for Medicare
• A child 1–18, an infant under 1, or pregnant
• A parent or caretaker relative of any age
• Dual-eligible (Medicaid + Medicare)
• Age 65+ and not seeking long-term care services
• Applying for the Medicare Savings Program

Apply through your Local Department of Social Services (LDSS)

Find your county LDSS at health.ny.gov/health_care/medicaid/ldss.htm. Apply through LDSS if you are blind or disabled (not in a MAGI group), need community-based long-term care, are an SSI recipient, are participating in the Excess Income Program, or are applying for nursing facility services. Non-MAGI applicants use form DOH-4220 (Access NY Health Insurance Application), often paired with DOH-5178A (Supplement A).

In New York City

NYC residents apply through the Human Resources Administration (HRA). HRA Medicaid Helpline: (888) 692-6116. HRA Infoline: (718) 557-1399. Some HRA Medicaid cases are administered by NY State of Health depending on category.

Phone applications and facilitated enrollers

Call the Medicaid Helpline at (800) 541-2831. Aged, blind, and disabled applicants can get free in-person help from Facilitated Enrollers contracted by DOH — DOH publishes a county-by-county list at health.ny.gov/health_care/medicaid/fe_abd.htm.

Decision timelines

• General Medicaid — 45 days from application
• Pregnancy and children — 30 days
• Disability-based determinations — up to 90 days

Immediate need for personal care or CDPAS

If you have an urgent need for Personal Care Services or Consumer Directed Personal Assistance Services, you can request expedited processing. Submit the Access NY application, Supplement A if needed, a physician's order (DOH-4359 or HCSP-M11Q or DOH-5779), and a signed Attestation of Immediate Need (DOH-5786). LDSS must make an eligibility decision within 7 days and a PCS/CDPAS determination within 12 days of receiving complete information.

If your application is denied

You have a right to a fair hearing. For LDSS or HRA decisions, request a hearing at (800) 342-3334 or online at otda.ny.gov/hearings/request. For Marketplace decisions, contact NY State of Health at (855) 355-5777. Your existing Medicaid coverage can stay in place while the appeal is pending.

What New York Medicaid covers

New York Medicaid covers a broad benefit package. Most members are enrolled in a Medicaid Managed Care plan; others use a fee-for-service Medicaid Benefit Identification Card. Members 21 and over may face small co-payments on some services; managed care members generally have no co-pays. Members under 21, pregnant members, and several other groups are exempt from all co-pays.

Core medical benefits

• Preventive care, well visits, immunizations
• Doctor and specialist visits, hospital inpatient and outpatient care, lab and X-ray
• Prescription drugs, smoking cessation agents
• Dental care (preventive and treatment)
• Vision care and eyeglasses
• Mental health services and substance use disorder treatment
• Family planning and reproductive health services
• Prenatal, delivery, postpartum (12 months) care
• Transportation to medical appointments — public transit and mileage reimbursement
• Emergency ambulance services
• Durable medical equipment, prosthetics, hearing aids
• Some Medicare and other-insurance premiums (through Medicare Savings Programs)

EPSDT — Child/Teen Health Program

Members under 21 receive Early and Periodic Screening, Diagnosis, and Treatment benefits under the federal EPSDT mandate, delivered in New York as the Child/Teen Health Program (C/THP). Covered services include scheduled checkups, vision, dental, hearing, behavioral health, and any medically necessary service for a child even when adult Medicaid does not cover the same service.

Long-term care

Most long-term care services run through Managed Long-Term Care (MLTC) plans for members needing 120+ days of community-based long-term care. Services include personal care, Consumer Directed Personal Assistance Services (CDPAS), home health, adult day health care, hospice, and nursing facility services. The 60-month lookback rule applies when applying for nursing facility Medicaid — transfers for less than fair market value during the lookback can trigger a transfer penalty.

Co-payment structure

Co-pay maximum: $50 per quarter, $200 per year (April 1 – March 31). Members exempt from co-pays include children under 21, pregnant members (through pregnancy plus two postpartum months), family planning services, nursing home and Adult Care Facility residents, hospice members, HCBS and TBI waiver enrollees, and members under 100% FPL.

Sister programs covered by DOH

• Child Health Plus — coverage for children under 19 above Medicaid limits
• Essential Plan — Basic Health Program for adults above Medicaid but at or below 250% FPL; very low premiums and broad benefits
• Family Planning Benefit Program — covers family planning when income is over Medicaid limits
• Medicare Savings Program (MSP) — premium assistance for low-income Medicare beneficiaries
• AIDS Drug Assistance Program (ADAP) — HIV medication assistance for the uninsured and underinsured

Other state Medicaid pages