What documentation is required for Medicaid in New York state? A guide
That's because the federal bill includes a $1 trillion reduction in spending over the next decade for Medicaid, the state-federal government insurance program for low-income Americans. And a big chunk of those cuts involve imposing a nationwide Medicaid work requirement that takes effect Jan. 1, 2027.
The legislation requires "able-bodied" Medicaid recipients to work 80 hours a month or qualify for an exemption, such as being a student, caregiver or having a disability. The work requirement applies to parents of children older than 13.
Further, the bill requires states to double Medicaid eligibility checks to twice a year. And states, which administer Medicaid, would have to set up systems to verify a person's employment or exemption status.
While it remains unclear exactly what state regulators would use to verify Medicaid recipients are meeting the new work requirement. Below are key details to know about the Medicaid enrollment process under the current state-run program.
Medicaid, like all 'means-tested' programs where eligibility is based on income and assets, requires extensive documentation to establish eligibility, state records show.
Proof is required to verify identity, residence, citizenship, disability (if the applicant is under 65 and is claiming to have a disability), marital status, income and resources and, in some cases, other information which may be necessary for an eligibility determination.
The documentation includes:
Personal identification — Birth certificate; baptismal certificate; hospital certificate of birth; passport or immigration papers; current driver's license.
Financial information — Documentation must be submitted to verify all sources of earned and unearned income. The applicant's total monthly income will be compared against the Medicaid income standard to determine if the applicant has excess income. Applicants with excess income are offered Medicaid under the Surplus Income Program.
Those income records include: Award letter from a benefits program; copy of check from benefits program; pay stubs showing earnings; bank statement of interest earned.
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Asset and resource statements for the last 36 months — Medicaid requires all applicants to open their financial history to a review process. The purpose is to see if the applicant has any unreported income or whether there are any large withdrawals that are not allowed by the Medicaid program.
This documentation includes:
savings bank books
checking statements
stock and bond certificates
life insurance policies
burial fund, burial plot, or funeral agreement deed to real property
If the documents requested by the Medicaid agency are not obtainable, the applicant should present any substitute evidence available to establish eligibility. Medicaid is jointly responsible with the applicant for exploring all factors concerning eligibility and should assist the applicant.
There are various Medicaid enrollment assistance programs through NY State of Health, the state-run health insurance marketplace.
That includes assistors and brokers who are certified experts who provide free and personalized Medicaid application and enrollment assistance to individuals, families, and small businesses.
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To speak with the NY State of Health marketplace customer service center call (855) 355-5777. You can also call the the Medicaid helpline (800) 541-2831.
There are also staff members at local Department of Social Services Offices devoted to aiding with the Medicaid enrollment process. A list of those offices is available through the Health Department's website, at health.ny.gov.
That Social Services list includes the Monroe County offices at 111 Westfall Road, Rochester (585) 753-2750 and Westchester offices at White Plains District Office, 85 Court St., White Plains (914) 995-3333.
This article originally appeared on Rockland/Westchester Journal News: Medicaid in NY: What documentation is required? A guide, what to know
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