The Medical Assistance Program (MA) commonly referred to as Medicaid was instituted in New York State in 1966 to provide services to the medically needy enabling the state to make payments directly to participating providers of medical care, such as, hospitals, doctors, druggists, etc. Our agency utilizes the following Managed Care providers:
- CDPHP – Capital District Physicians Health Plan
- FI – Fidelis
- GHI – Group Health Inc.
To qualify, applicants must meet prescribed income and resource requirements.
- General Medical Assistance – This area includes many different budgets and eligibility criteria and is the bulk of the program. Income and resources along with household size is the major bases for determining eligibility.
- Buy-In Program – Some applicants who are over income but have large monthly medical bills may participate in this program. Recipients pay to the agency on a monthly basis set amount of money, or, show proof of monthly bills they have paid, then Medicaid coverage results.
- Chronic Care (Nursing Home Clients ) – Medicaid coverage for eligible low income clients who have need of a 24 hour nursing home facility.
- Persons In Receipt of SSI – A person receiving SSI is automatically eligible to receive Medicaid coverage but must submit a completed application.
Agency Supporting Programs
- Medicaid Transportation – Clients receiving Medicaid/Managed Care are entitled to transportation to and from doctor or health related visits and appointments. Arrangements are made by phoning (855)360-3545
- Prenatal Care Assistance Program (PCAP) – This program is designed for pregnant women to get the care they need by having PCAP participating doctors make a temporary determination of eligibility which can allow clients to receive prenatal care for up to 45 days. Coverage will not continue beyond 45 days unless the applicant completes the application process at Social Services. There is no limit on resources an applicant may have.
- Child/Teen Health Plan (C/THP) – This provides a preventive health program for Medicaid eligible children under the age of 21 and in need of medical and dental care. The program pays for initial and periodic examinations coordinating all necessary health care for eligible children. All managed care participants are included in this program.
- Aid to Disabled (AD) and Disabled Client Assistance Program (DCA) – DCA gives special assistance to disabled clients for the purpose of applying for Supplemental Security Income or other types of disability. AD can provide program benefits to disabled clients who have met criteria through documentation, examination, medical test and consultation. The cost will be covered by the agency. Referrals come from eligibility workers in Temporary Assistance and Medicaid.
- Third Party Health Insurance (TPHI) – This program utilizes all private health insurance a client may have, therefore, reducing the amount of Medicaid participation. When cost effective the agency may decide to pay for the client’s private insurance premiums or Medicare. Private insurance as well as Medicare are utilized before Medicaid benefits are used.