Medical Assistance

Medical Assistance Nursing Home Care

The Medicaid Nursing Home Care (previously chronic care) Unit processes Medicaid applications for those individuals who are seeking help in paying for nursing home or long term home health care services.

Financial eligibility is determined based on the income and resource standards governing the Medicaid Program. A Supplemental Security Income recipient is granted Medicaid based upon his/her certification for SSI Benefits.

The amount of assistance that the Medicaid program will pay toward the cost of nursing home and/or home care services is determined using a comparison of the available income and resources of the applicant against the cost of the medical services needed. Since each financial and medical circumstance is unique, the regulations and policies governing what assets are exempt and what assets are used in the determination of eligibility vary, therefore, income and resource standards are not listed here. Anyone who needs financial assistance in paying for nursing home or long term home health care services is encouraged to contact our office for consultation regarding their specific need for benefits.

WHAT DOCUMENTS WILL YOU BE ASKED TO PROVIDE?

The law requires that you provide documentation to verify your sources of income, your assets, birth date, marital status, and citizenship, as well as some other items. Below is a list of some of the items that will be required.

Birth certificates for the applicant and spouse
Social security cards for the applicant and spouse
Alien registration card / I-94 card / Naturalization papers for the applicant and spouse
Marriage certificate or separation papers or divorce papers
Death certificate(s) of spouse(s)
Veteran Discharge papers for applicant and /or spouse
Power of Attorney Papers
Written Authorization to Represent the Applicant
Medicare and other health insurance cards and verification of monthly premiums
Verification of ALL sources of income for the applicant and the spouse, such as but not limited
to: wages, social security, pensions, veterans and military benefits, interest and dividend
income. The gross amounts must be verified, with all deductions, and the frequency with
which the income is received.
Verification of ALL the assets of both the applicant and spouse MUST be documented. Examples of some types of assets that must be documented are (but not limited to): checking & savings accounts,CD’s, stocks, bonds, mutual funds, retirement funds, annuities, Life insurance policies, burial spaces, burial funds, all properties owned, vehicles, mobile homes and RV’s.

If you are seeking nursing home services, monthly statements for all financial accounts for the 60 months prior to the date of application must be provided. This includes accounts currently closed but that were active at any time in the 60 month look back period. If the applicant or spouse set up a trust or are the beneficiaries of a trust, the trust document must be provided and all assets owned by the trust must be documented for the 60 months prior to the date of application.

Once an application is received and reviewed if any further documentation is required a pending letter will be issued. This letter will include the name and phone number of the individual processing the application as well as a due date for submission of the information.

RENEWAL OF ELIGIBILITY & REPORTING RESPONSIBILITY

If you are found eligible for ongoing Medicaid benefits you will be required to re-establish your eligibility at regular intervals as determined by the New York State Social Welfare law. This is called recertification or renewal. You will receive notification of your recertification/renewal by mail. The completed form must be returned by the due date listed in the notice for your benefits to continue.

Medicaid Community Unit

The Medicaid Community Unit processes applications for a variety of public health insurance programs including Medicaid, Prenatal care services (Presumptive Eligibility), Family Planning Benefit Program and the Medicare Savings Program.

Financial eligibility is determined based on the income and resource standards governing the Public Health Insurance Programs. A Supplemental Security Income recipient is granted Medicaid based on his/her certification for SSI benefits. A separate application for Medicaid is not needed for SSI recipients.

Persons eligible for Medicaid may be required to enroll in a managed care plan. Managed Care information and options will be provided upon application.

You can obtain more information online at www.mybenefits.ny.gov.

PREGNANT WOMEN MAY APPLY FOR PRENATAL CARE SERVICES (PE) AT THE FOLLOWING SITES:

Family Planning (315) 435-3295
Planned Parenthood (315) 475-5540
St. Joseph’s Maternal Child Health Center/St. Joseph’s family medicine (315) 448-6146
Syracuse Community Health Center (315) 476-7921 ext 2327
UHCC/Womens Health Care Services (315) 464-5210

The following may apply by calling their local DSS at (315) 435 – 2700

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 services (CBLTC)
Medicare Savings Program (MSP)
Medicaid buy-in for Working People with Disabilities enrollees (MBI-WPD)
Residential treatment center/community residences operated by the Office of Mental Health (OMH)
Presumptive Eligibility (PE) for pregnant women apply with provider, processed by the LDSS

WITH THE APPLICATION, THE FOLLOWING DOCUMENTATION MUST BE PRESENTED:

Birth Certificates for all persons who are applying
Social Security Card for all who are applying
Proof of citizenship status
Veteran Discharge papers (if applicable)
Verification of ALL income, including but not limited to: wages, Social Security, pensions, veteran’s benefits and interest or dividends
Depending on your circumstances you may be asked to verify ALL your resources, including but not limited to: bank accounts, trust funds, insurance, CDs, burial accounts, burial spaces, vehicles and property.
Medicare and other health insurance cards and verification of premium cost

RENEWAL OF ELIGIBILITY & REPORTING RESPONSIBILITY

If you are found eligible for ongoing Medicaid or another Public Health Insurance Program you will be required to re-establish your eligibility at regular intervals as determined by the New York State Social Welfare law. This is called a “Renewal”. You will receive notification of your renewal and a renewal form by mail. It must be retuned by the date in the notice for your benefits to continue. You will need to send in verifying documentation such as:

Verification of ALL income, including but not limited to wages, Social Security, pensions, veteran’s benefits and interest or dividends
Depending on your circumstances you may be asked to verify ALL your resources, including but not limited to bank accounts, trust funds, insurance, CDs, burial accounts, burial spaces, vehicles, and property.
Medicare and other health insurance cards and verification of premium cost