GIS 16 MA/009: Revised DOH-4220: Access NY Health Care Application

To: All Local District Commissioners, Medicaid Directors

From: Judith Arnold, Division of Eligibility and Marketplace Integration

Subject: Revised DOH-4220: Access NY Health Care Application

Effective Date: Immediately

Contact Person: Local District Support Unit
Upstate (518) 474-8887 New York City (212) 417-4500

The purpose of this General Information System (GIS) message is to inform local departments of social services of revisions to the "Access NY Health Care" Application (DOH-4220). With the implementation of the Affordable Care Act (ACA) and the commencement of NY State of Health on January 1, 2014, individuals seeking Medicaid coverage who are in a Modified Adjusted Gross Income (MAGI) category no longer apply through the local districts using the Access NY Health Care application. The Access NY Health Care application will only be used for individuals in a non-MAGI category, with a few exceptions. For example, presumptive eligibility for pregnant women and children done with the assistance of a provider are still processed by the local districts and will continue to use the Access NY Health Care application. In addition, individuals applying for nursing home coverage should apply using the Access NY Health Care application.

To accommodate certain program changes, including the elimination of the Family Health Plus program and the required processing of all Child Health Plus applications through the NY State of Health, the Access NY Health Care application required certain modifications. The Access NY Health Care application has been updated with the following revisions:

  • Removal of all language regarding applying for Family Health Plus and Child Health Plus;
  • Removal of the requirement to provide proof of pregnancy;
  • Removal of the question about lost/canceled health insurance within the last 6 months; and
  • Elimination of the DOH-4220C, Access NY Health Insurance and Nutrition Fact Sheet (captioned "Health Insurance / Medicaid / Family Health Plus / Child Health Plus").

The updated application has been posted to the New York State Department of Health (DOH) website and will be printed and stocked in the DOH warehouse. The revised Access NY Health Care application will be available from the warehouse when the printing has been completed. The revision date is 3/2016.

Please direct any questions to your local district liaison.