Medicaid Managed Care in New York provides free or low-cost health coverage for low-income individuals. Seniors who receive Supplemental Security Income (SSI) automatically qualify for Medicaid.
Benefits include:
- Primary care physician visits
- Blood tests and X-rays
- Emergency care
- Yearly exams
- Hearing, vision and dental
- Durable medical equipment
- Nursing home care
To qualify for Medicaid benefits, individuals must:
- Be a U.S. citizen or qualified alien
- Be a permanent resident of New York
- Be blind, disabled or at least 65 years old
- Have a monthly net income below $859 and resources totaling $15,450 or less (single) or a monthly net income below $1,267 and resources totaling $22,800 or less (couple)
Medicaid doesn’t pay for assisted living, but waivers are provided by the program to help with services that may otherwise be an out-of-pocket expense. The Assisted Living Program (ALP) provides a broad range of services to Medicaid recipients who are medically eligible for nursing home placement but have a degree of mobility to function in an approved assisted living facility.
Benefits and services paid for by the ALP program include:
- Room and board
- Personal care assistance
- Housekeeping
- Personal emergency response services
- Physical, occupational and speech therapy
- Medical supplies and equipment
To qualify for this program, individuals must:
- Be over 21
- Not require continuous nursing care
- Be medically eligible for nursing home care
- Meet Medicaid income requirements
The ALP program has a limited enrollment of 4,200 residents, and it’s not unusual to be placed on a waiting list.
New York has three other Managed Long-Term Care (MLTC) programs for individuals who prefer to receive services at home or in an assisted living residence rather than a nursing home facility. Seniors may apply to one of the following:
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MLTC Medicaid Plan: Manages Medicaid services only
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Medicaid Advantage Plus: Manages both Medicaid and Medicare services
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Program for All–Inclusive Care for the Elderly (PACE): Manages both Medicaid and Medicare services
Benefits and services provided by all three plans include:
- Adult day health care
- Care management
- Congregate and home delivered meals
- Nutrition counseling
- Personal care services
- Personal emergency response service
- Prostheses and orthodontics
- Rehabilitation therapies
Eligibility guidelines include:
- Must be age 65 or older (or 55 for PACE)
- Must be medically eligible for nursing home care
- Income and assets must fall within New York’s Medicaid limits
Applicants who are interested in Medicaid, the ALP or the MLTC programs can contact their local social services district at Dutchess County DSS or call (845) 486-3000.