The Medicaid Unit determines eligibility for several of the programs included in New York’s Medicaid program. The primary programs include full Medicaid which pays for all medical care, and Chronic Care which pays for nursing home and other long-term care services. Smaller programs cover Medicare premiums, AIDS health insurance premiums, family planning services, Medicaid for the working disabled and for pregnant women. Each program has its own eligibility criteria.
Q. How do I apply for Medicaid?
Applicants under age 65 and not disabled (including the individuals below) should apply through the New York State of Health (NYSOH) website (also known as the Health Benefit Exchange) https://nystateofhealth.ny.gov
- Adults (not pregnant) and aged 19-64, not eligible for Medicare
- Pregnant Women and Infants
- Children ages 1 - 18
- Parents and Caretaker Relatives
New York State Department of Health - Contracted Navigators
Call 211 on your phone to reach a Navigator who will help you assess your needs and will link you directly to resources that can help. Currently Ontario County Residents call this number and are redirected to an outside agency that assists with this application process.
You can also visit the New York State of Health website, or call (855) 355-5777 for assistance applying over the phone.
The following individuals should apply with their Local Department of Social Services (LDSS):
- Individuals age 65 and older, who are not parents or caretaker relatives, when age is a condition of eligibility;
- Individuals whose eligibility is based on being blind or disabled, or who request coverage for community based long-term care (CBLTC) services; including those individuals with an immediate need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Services (CDPAS);
- Medicare Savings Program (MSP); https://www.health.ny.gov/forms/doh-4328.pdf (link for 2 page application);
- Medicaid Buy-In for Working People with Disabilities enrollees (MBI-WPD);
- Former Foster Care youth;
- Residents of adult homes and nursing homes;
- Residential treatment center/community residences operated by The Office of Mental Health (OMH); and
- Presumptive Eligibility (PE) for Pregnant Women apply with provider, processed by the LDSS.
For applicants over 65 years old or disabled, please contact (585) 396-4433 for an application and Supplement A. Applications and Supplement A can also be obtained from the New York State Department of Health.
Chronic Care Medicaid
Chronic Care Medicaid is available for income-eligible individuals who are in need of nursing home placement or medically necessary home care services. The Chronic Care eligibility process is the most complex of the Medicaid processes, requiring staff to review 60 months of bank records and to conduct data searches for real estate and other assets.
Applications are available at the Ontario County Department of Social Services, 3010 County Complex Drive, Canandaigua, NY 14424. To request an application by phone, call (585) 396-4433 and your call will be redirected to an employee who specializes in this program.
Q. How do I order Medicaid transportation to a medical appointment?
- If you are enrolled in managed care plan, contact your managed care provider for assistance.
- If you are an Ontario County Medicaid recipient, you may call 855-733-9402 or 315-299-2786 (Medical Answering Service) to request transportation to medical appointments. Additional information can be found at https://www.medanswering.com/locations/nys/flnny/ontario/
Q. How do I report Medicaid Provider or Consumer Fraud?
To report provider or consumer fraud, you may call 1-877-87FRAUD (1-877-873-7283).
Q. Where do I get information the Prenatal Care Assistance Program?
For more information about the Prenatal Care Assistance Program visit the NYS Department of Health website
Q. Where do I call for information about Medicaid Managed Long Term Care programs?
For information about Managed Long Term Care programs, please call New York Medicaid Choice at 1-888-401-6582.
Q. Where do I get information about the New York State Partnership for Long Term Care?
For information about the New York State Partnership for Long Term Care visit https://nyspltc.health.ny.gov/
Q. Where do I call for an application for Child Health Plus?
For more information about Child Health Plus please visit the NYS Department of Health website or call 1 (800) 698-4543.