Medicaid is government health insurance that covers doctor visits, hospital care, prescriptions, mental health services, dental care, and more — at little or no cost to you. In New York City, Medicaid eligibility is broader than in most states, and millions of New Yorkers qualify without knowing it. This guide walks you through who qualifies, what it covers, and exactly how to apply.
Who Qualifies for Medicaid in New York City?
New York has one of the most expansive Medicaid programs in the country. Eligibility is based primarily on income relative to the Federal Poverty Level (FPL). General thresholds under current program rules:
- Adults under 65: Income at or below 138% FPL — approximately $20,120/year for a single person (figures adjust annually; verify at nystateofhealth.ny.gov)
- Children under 19: Covered under Child Health Plus up to higher income levels
- Pregnant individuals: Higher income threshold applies during pregnancy and postpartum period
- Seniors 65+ and people with disabilities: Different income and asset rules — contact HRA for your specific situation
Immigration status: U.S. citizens and most lawfully present immigrants qualify for full Medicaid. Undocumented immigrants do not qualify for full Medicaid but are eligible for emergency Medicaid (emergency care, labor and delivery, treatment for certain conditions). New York City also has NYC Care for uninsured New Yorkers regardless of immigration status.
What Does New York Medicaid Cover?
- Primary care and specialist physician visits
- Hospital inpatient and outpatient care
- Emergency room services
- Prescription drugs (with a broad formulary)
- Mental health and substance use disorder treatment
- Dental care for adults — New York provides comprehensive adult dental, unlike many states
- Vision care and eyeglasses
- Prenatal and postpartum care
- Home health and personal care services
- Medical equipment and supplies
There are generally no premiums for most Medicaid enrollees in New York, and copayments are minimal or waived for those with the lowest incomes.
How to Apply for Medicaid in NYC: Four Ways
1. Apply Online at NY State of Health (Fastest)
Go to nystateofhealth.ny.gov and create an account to apply. The online application also screens you for Child Health Plus and the Essential Plan (for those just above the Medicaid income limit). Available 24/7. Most straightforward cases receive a quick eligibility determination.
2. Apply by Phone
Call NY State of Health at 1-855-766-7860 (TTY: 1-800-662-1220), Monday–Friday 8am–8pm, Saturday 9am–1pm. A trained enrollment assistant will walk you through the application.
3. Apply In Person at an HRA Office
Visit any NYC Human Resources Administration Benefits Access Center to apply with in-person assistance. Find your nearest office at nyc.gov/hra or call 311. Staff can help with the application and document submission.
4. Apply Through a Free Community Navigator
Certified Navigators and Application Counselors provide free enrollment help at community organizations, health centers, and libraries across all five boroughs. Find one near you through NY State of Health’s navigator search at nystateofhealth.ny.gov.
Documents You Will Need
- Photo ID (driver’s license, passport, or other government-issued ID)
- Proof of New York State residency (lease, utility bill, or official mail with your address)
- Social Security number for qualifying household members
- Proof of income: recent pay stubs, employer letter, tax return, or benefit award letters (Social Security, disability, unemployment)
- Immigration documents if applicable
If you don’t have all documents, apply anyway. You can submit documentation after starting the application — missing paperwork should not delay you from beginning the process.
After You Apply
Medicaid determinations are required within 45 days for most applicants (90 days for disability-based cases). During processing you may be asked to provide additional documentation. If approved, coverage is typically retroactive to the month you applied — meaning care you received while your application was pending may be covered.
If you need care urgently before your application is processed, tell your provider you have a pending Medicaid application — many providers will see you on that basis and bill Medicaid once approved.
If You Earn Too Much for Medicaid: The Essential Plan
If your income is above the Medicaid limit but at or below 200% of the FPL, you likely qualify for New York’s Essential Plan — low-cost or no-cost health coverage with no premiums for most enrollees and minimal copays. Apply through the same NY State of Health application.
NYC Care: Health Access Regardless of Immigration Status
NYC Care is a city health access program for New Yorkers who don’t qualify for insurance due to immigration status or other factors. It connects you to care at NYC Health + Hospitals facilities — the city’s public hospital network — with fees on a sliding scale based on income (free for those with no income). Enroll at nyccare.nyc or call 1-646-NYC-CARE (1-646-692-2273).
Frequently Asked Questions
Can I get Medicaid if I’m undocumented?
Undocumented immigrants qualify for emergency Medicaid covering emergency care, labor and delivery, and certain other services. NYC Care provides broader access to the city’s public hospital system for all New Yorkers regardless of status.
I have a job with employer health insurance. Can I still get Medicaid?
Possibly. Having employer coverage doesn’t automatically disqualify you if your income falls within the Medicaid range. Medicaid may act as secondary coverage. Apply and NY State of Health will assess your situation.
My application was denied. What can I do?
Request a fair hearing with the NYS Office of Temporary and Disability Assistance (OTDA) within 60 days of the denial notice. Community Health Advocates offers free help with Medicaid appeals at communityhealthadvocates.org.
Does Medicaid cover dental for adults in NYC?
Yes. New York Medicaid provides comprehensive adult dental coverage including cleanings, fillings, extractions, and dentures. NYC Health + Hospitals dental clinics accept Medicaid — call 1-844-NYC-4NYC to find a location.
How long does it take to get approved?
Most cases are decided within 45 days of a complete application. If you need care sooner, inform your provider you have a pending application — coverage if approved is retroactive to your application month.
