Guidance for Medicaid Consumers Enrolled Through their Local Department of Social Services

FACT SHEET

  • Fact Sheet is also available in Portable Document Format (PDF)

What You Should Know About:

Medicaid Coverage through Your Local Department of Social Services during the Coronavirus Emergency*

FREQUENTLY ASKED QUESTIONS about Medicaid coverage during the COVID-19 State of Emergency for consumers enrolled through their Local Departments of Social Services.

Applying for Medicaid During the COVID-19 State of Emergency

1. Do I include my federal stimulus payment and/or the Pandemic Unemployment Benefit as income on my Medicaid application?
  • No. Both the one-time stimulus check (up to $1,200 for single adults, $2,400 for married couples, $500 for children under age 17) and the weekly $600 Pandemic Unemployment Compensation checks do not count as income on your Medicaid application.
  • Any money that you have left 12 months after receiving these payments, will count as a resource.
2. My elderly relative is in a hospital or nursing home and cannot sign the Medicaid application. Can I submit the application for them?
  • During the COVID-19 emergency, you can help your relative apply for Medicaid by submitting the Access NY Health Care application (DOH-4220-I form) and signing the Supplement-A (DOH-5178A form) on your relative´s behalf. You will also need to complete and sign the Submission of Application on Behalf of Applicant (DOH-5147 form or MAP-3044 for NYC applicants). This allows the application to be processed without the applicant´s signature.
3. I received a telephone call and email saying that my Medicaid application was missing information. What should I do?
  • During the COVID-19 emergency, your local district may contact you by telephone or email to get the missing information.
  • The district will make three attempts to contact you, your authorized representative, or the person who submitted your application for you.
  • If your district cannot reach you, they will send a written request for the missing information, with a due date of no less than 10 days. The written request will tell you how you can provide the missing information. If you don´t provide the missing information your application may be denied.
4. I am over 65 and need a disability determination so that I can apply for Medicaid using a pooled trust. I cannot get an appointment with my doctor to complete, sign, and date the NYS disability papers because of the COVID-19 emergency. What can I do?
  • You should first contact your local district and file your Medicaid application. Your local district staff and Department of Health staff can then help you with the necessary paperwork to process your disability determination. They can also help if you are under age 65 and need a disability determination for Medicaid.

Maintaining Medicaid Coverage During the COVID-19 Emergency:

5. Could I lose my Medicaid coverage if I forget to renew it during the COVID-19 emergency?
  • No. Everyone with Medicaid coverage on or after March 18, 2020 will keep their coverage unless they cancel it or move out of New York State during the COVID emergency. You do not need to take any action to keep your coverage.
    • If your case was closed and you had coverage on or after March 18, 2020, your coverage should now be reinstated.
    • If your case is closed, call the NYS Medicaid Helpline at 1-800-541-2831 for help.
6. I cannot provide information about my child´s absent parent due to the COVID-19 emergency, which is a condition of my Medicaid eligibility. Will I be able to enroll in or keep my Medicaid coverage?
  • Yes. During the COVID-19 emergency, you will not be required to comply with child support requirements in order to enroll in or maintain Medicaid coverage.
7. I requested a fair hearing and I was granted Aid to Continue. How will that affect my Medicaid coverage?
  • During the COVID-19 emergency, your Medicaid coverage will continue under Aid to Continue status even if you lose your fair hearing.

Providing Proof of Eligibility for Medicaid Coverage During the COVID-19 Emergency:

8. I have been unable to provide proof of income and resources to my local district during the COVID-19 emergency. What should I do?
  • Contact your local district. They will allow you to attest to the information that determines your Medicaid eligibility over phone or email, instead of providing documentation. You can attest to the following:
    • Income
    • Assets, if applicable, and how you have used them in the past
    • Retirement accounts and annuities, however you may be required to provide proof at renewal
    • Social Security benefit amount
9. I have been unable to provide proof of my identity or immigration status to my local district during the COVID-19 emergency. What should I do?
  • If you are otherwise eligible, your Medicaid coverage will start. You will be granted a 90-day reasonable opportunity period to provide the necessary documents.
    • If the COVID-19 emergency is still in effect at the end of the 90-day reasonable opportunity period, and supporting documents are still needed, your coverage will be extended for a second 90-day period.
10. I participate in the Medicaid Excess-Income or Pay-In program, but I have been unable to submit a bill or payment due to the COVID-19 emergency. What should I do?
  • Contact your local district or, if you pay your spenddown to a Managed Long Term your Care Plan, contact your plan, as soon as possible. Explain that you haven´t been able to submit your bills or pay your spenddown due to the COVID-19 emergency.
  • Save your receipts or the monthly amounts of your pay-in (spenddown) because you may be asked to provide them at the end of the COVID-19 emergency period.
11. During the COVID-19 Emergency Period, do I:
  • Need proof that I am taking my maximum Individual Retirement Account (IRA) distribution?
    • During the COVID-19 emergency, your local district will count the actual distribution amount received from your IRA as income. The determination of whether this amount is the maximum distribution available will be deferred until the next time you renew your eligibility.
  • Need proof that I made an irrevocable burial agreement?
    • Yes. For burial agreements, you must submit proof that the agreement is final and irrevocable.
  • Need proof that my money is in an appropriate trust for Medicaid eligibility?
    • Yes. Copies of all trust documents are still required.

Medicaid Coverage with Other Benefits During the COVID-19 Emergency:

12. I turned 65 but haven´t been able to apply for benefits such as Medicare or Social Security due to the COVID-19 emergency. Will my current Medicaid coverage be affected?
  • No. During the COVID-19 emergency you will not be required to apply for other benefits, such as Medicare or Social Security.
13. I have been unable to complete my application for Veterans Benefits due to the COVID-19 emergency. Will I be able to enroll in or keep my Medicaid coverage?
  • Yes. During the COVID-19 emergency, you will not be required to apply for Veterans Benefits.
14. I have been unable to provide my local district with Third Party Health Insurance (TPHI) information, including that my TPHI has ended. What should I do?
  • You will not be required to provide TPHI information in writing, but tell your local district if your insurance has ended or if there are any other changes to your TPHI.
15. I was making voluntary re-payments for overpayments I received as reimbursement for my Third Party Health Insurance (TPHI) but I am unable to make the payments right now due to the COVID-19 emergency. What should I do?
  • You may stop making re-payments, and start them again as soon as you are able.
16. I am in the Medicaid Buy-In Program for Working People with Disabilities (MBI-WPD) program, and I lost my job due to the COVID-19 emergency. Will I lose my Medicaid coverage?
  • No. Although you must maintain a job to stay in the program, you are allowed a six-month grace period if you became unemployed by no fault of your own and intend to return to work as soon as you are able. During this COVID-19 emergency, an additional six-month period will be provided if needed to look for new employment.

* The Coronavirus (COVID-19) State of Emergency or COVID-19 emergency means the federal public health emergency period as designated by the Secretary of Department of Health and Human Services.