Medicaid is a program for New Yorkers who can’t afford to pay for medical care.
Ulster County provides two comprehensive Medicaid programs:
- Fee-for-service Medicaid, in which some services require a small co-payment; and
- Managed Care Medicaid. Enrollment in a Medicaid managed care program through a Health Maintenance Organization (HMO) is an Ulster County option.
When you join a managed care program, you will choose a personal doctor who will be responsible for making sure all your health care needs are met. The doctor will send you to someone else if you need more help than he or she can provide.
Managed care covers most of the benefits recipients will use, including all preventive and primary care, inpatient care and eye care. People in managed care plans use their Medicaid benefit card to get these services that the plan does not cover.
In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan.
- smoking cessation agents
- treatment and preventive health and dental care (doctors and dentists)
- hospital inpatient and outpatient services
- laboratory and X-ray services
- care in a nursing home
- care through home health agencies and personal care
- treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
- medicine, supplies, medical equipment and appliances (wheelchairs, etc.) Under new federal legislation, effective January 1, 2006, Medicare, not Medicaid, will be the primary payer of prescription drugs for dual eligible recipients (persons who qualify for both Medicare and Medicaid).
- clinic services
- transportation to medical appointments, including public transportation and car mileage
- emergency ambulance transportation to a hospital
- some insurance and Medicare premiums
- other health services
Information about keeping assets if you are in a nursing home or intermediate care facility:
Medicaid allows a recipient to keep a small amount of income for personal needs. You can also keep some of your income for your family if they are dependent on you. A spouse who remains in the community may also keep resources and income above the allowable income levels. You may call the Ulster County Medicaid Division at (845) 334-5170 for additional information or clarification.)
Will there be a legal claim (lien) placed on my estate (assets) when I die?
If you receive medical services paid for by Medicaid on or after your 55th birthday, or when permanently residing in a medical institution, Medicaid may recover the amount of the cost of these services from the assets in your estate upon your death.
You may be covered by Medicaid if:
- You have high medical bills
- You receive Supplemental Security Income (SSI)
- You meet certain income, resource, age, or disability requirements.
Income and resource requirements are subject to yearly adjustments. You may also own a home, a car and personal property, and still be eligible.
In order to determine if you qualify, please call the Ulster County Department of Social Services Medicaid telephone number at (845) 334-5045 to set up an appointment. If you are home-bound, call Ulster County Department of Social Service to find out how you can apply without visiting the office. Senior citizens may also call the Ulster County Office for the Aging at (845) 340-3456 to receive help with application and eligibility.
If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services.
For you to use your Benefit Identification Card for certain medical supplies, equipment or services (for example, wheelchair, orthopedic shoes, transportation) you or the person or facility that will provide the service must receive approval before the service can be provided (prior approval).