Herkimer County

Medicaid - Medical Assistance

Table Of Contents:

Medical Assistance

Medical Assistance is help for people who cannot pay for all of their medical care.
There are several programs available under Medical Assistance:

  • Child Health Plus A provides health care coverage for children under the age of 21, when their family income is below certain levels.

  • Medicaid provides health care coverage for adults who have income and resources below certain levels.
  • Family Health Plus provides health care coverage for persons age 19 through age 64 who do not have other health insurance and who also have incomes too high to qualify for Medical Assistance or Child Health Plus A. There are income guidelines that must be met. Many of the rules for Medical Assistance also apply to Family Health Plus, but not all.

  • Family Planning Benefits Program: provides family planning services, certain helath education and related medical care to people of childbearing age who have income below certain levels. Services include: all FDA approved birth control methods, devices, and supplies, comprehensive reproductive health history, and physical/gynecological examinations, male and female sterilizations, pregnancy testing and counseling, and preconception counseling. Local county health departments, publicly supported family planning clinics, and Prenatal Care Assistance Program providers (family planning providers) will assist with completing applications and obtaining required documentation. Eligibility for the Family Planning Benefit Program will continue for 24 months unless eligibility circumstances change.

Medical Assistance may help pay for:

  • Health Insurance Premiums
  • Hospital inpatient and outpatient services
  • Home health care
  • Laboratory and X-ray services
  • Nursing home care
  • Treatment and preventive health and dental care (doctors and dentists)
  • Treatment in psychiatric hospitals (for persons under 21 or 65 and older), mental health facilities, and mental retardation and developmental disabilities facilities
  • Family planning services
  • Medicine and supplies
  • Clinic services
  • Emergency ambulance transportation to a hospital
  • Other health services

Medical Assistance may also help pay for the following, but the recipient or the person/facility providing the services must have the service approved ahead of time (prior approval):

  • Transportation to medical appointments, including bus tokens and car mileage
  • Personal care
  • Private Duty nursing
  • Certain Dental care
  • Durable medical equipment (wheelchairs, orthopedic shoes, etc)
  • Long term home health care under the Long Term Home Health Care Program (LTHHCP)

Eligibility Criteria:

Meet certain income, resource, age, disability or other requirements. Generally are eligible for Temporary Assistance or Supplemental Security Income (SSI)

Client Fees:

Generally there are no fees, but Medical Assistance recipients age 21 or older may be asked to pay part of the costs of some medical care/items. This is called a co-payment or co-pay. The health care provider is allowed to ask for the co-payment. For each 12 months, there is a $100 maximum per recipient for all co-payments. The provider cannot refuse to give the services or goods if the individual is unable to pay the co-payment.


Q. Can Medical Assistance pay for past medical bills?
A. Yes. Medical Assistance may pay for bills paid prior to filing a Medical Assistance application as well as any bills paid until the Medical Assistance Common Benefit Identification (CBIC) car is received. Bills paid before filing the Medical Assistance application must be for services received on or after the first day of the third month before the month the application is filed.

Q. How are emergency medical needs handled?
A. New York State law requires hospitals to give emergency care even if there is no payment available. If an applicant needs non-emergent medical care and has not received the Benefit ID card, a temporary card may be issued.

Q. If an individual gives away or transfers any money or property, can he/she still receive Medical Assistance?
A. An individual can keep certain money or property for him/herself and his/her family and still receive Medical Assistance. If the individual or his/her spouse transferred other money or property, Medical Assistance may not pay for the following medical care for a period of time, depending on how much money or property was transferred:

1. Nursing Home Care
2. Certain at-home care, which is like nursing home care
3. Care received in a hospital when hospital care is no longer needed and nursing home placement is pending.