Can I apply for Medicaid Health Insurance with the NYC Human Resources Administration (HRA)?

Who can apply for Medicaid at HRA?

If you are 65 and older, certified blind, or disabled and live in New York City, you generally apply for Medicaid health insurance with the Human Resources Administration (HRA). This type of Medicaid is called Aged, Blind, and Disabled (ABD).

What are the Medicaid income and resource limits?

To qualify for Medicaid, your income must be under a certain amount, which depends on age, disability, and household size. The Medicaid income and resource limits change every year around February or March. ABD Medicaid has both an income and a resource limit.

For ABD Medicaid, you can have income above the income limit, but generally you cannot have resources above the limit. Medicaid’s rules about what income and resources count can be complicated.

If you aren’t sure whether you are financially eligible for Medicaid, we recommend you read about Medicaid income and resource disregards (income and resources that count toward the limits) before applying.

How can I apply for ABD Medicaid?

You will need to complete and submit a two-part Medicaid application, along with the required supporting documents. You submit the application and documents to HRA. The Medicaid application has two parts—both parts are required. It is especially important to report all sources of income and resources.

• DOH-4220: https://www.health.ny.gov/forms/doh-4220.pdf
  • This application asks about household members, income, and living and medical expenses.
• DOH-5178a: https://www.health.ny.gov/forms/doh-5178a.pdf
  • This application asks about all resources, including checking & savings accounts, retirement accounts, stocks, bonds, annuities, investments, life insurance, burial funds, homes, and cars.

In addition to completing the two-part Medicaid application, you will also need to include supporting documents: They include:

• Proof of age & identity;
• Proof of address/residence;
• Proof of income & resources; and
• Proof of immigration status.
  (Note: New York State expanded Medicaid coverage for noncitizens 65 and older. If you are 65+ without an immigration status, you can still apply for Medicaid. You would fill out the application and submit all the other required documents except proof of immigration status. If you do have an immigration status & have Medicare health insurance, you can submit a copy of the Medicare card to prove your immigration status.)

Where can I submit the Medicaid application and documents?

You can submit the Medicaid application and documents in one of three ways.

• By Mail: Mail the application forms and copies of all documents to the Human Resources Administration. If you mail the application, please keep a copy for your records and mail it using certified mail with return receipt. It is important to keep proof of mailing for any application for Medicaid or other benefits. 
  
  Initial Eligibility Unit
  HRA/Medical Assistance Program
  PO Box 24390
  Brooklyn, NY 11202-9814
• By Fax: HRA’s fax number for new Medicaid applications is 917-639-0732. If you fax in your Medicaid application, make sure the fax machine is set to give you fax confirmation, which you should keep as proof of submission.
• Online via Access HRA (AHRA): Access HRA is a website and free app that lets you get information and apply for public benefits like Cash Assistance, SNAP (food stamps), and/or Medicaid. To apply for Medicaid via AHRA, you must first create an account (username and password) and then you log in and apply.

How long will it take HRA to review my Medicaid application?

HRA has forty-five (45) days to review your ABD Medicaid application and send you a decision notice by mail. The decision notice will either approve or deny your Medicaid application. Sometimes HRA will ask for more information before they send you a decision. If HRA asks for more information, you must respond and provide it or explain why you don’t have it. If you do not respond, HRA can deny your application.

What happens if I apply and I do not get a decision notice?

If you do not get a decision notice from HRA and it has been more than 50 days since you submitted the application, call the Medicaid helpline, 888-692-6116 and ask for an update. If HRA hasn’t made a decision on your Medicaid application, ask the helpline representative to escalate it to a supervisor.

What can I do if I don’t agree with HRA’s decision?

If you never get a decision notice, HRA denies your application, or you believe your Medicaid budget is wrong, you can ask for an appeal, called a fair hearing. Fair hearings can be requested online, by phone, or fax through the Office of Temporary & Disability Assistance (OTDA).

For free legal help, call Legal Services NYC at 917-661-4500 Monday through Friday from 9:30 a.m. to 4 p.m. Learn more about our intake process here.

* The information does not constitute legal advice. You should always consult an attorney regarding your matter. Legal help subject to capacity and location.