Before the Covid-19 pandemic, anyone who got Medicaid benefits in New York City could be investigated for their past or present eligibility for Medicaid. These investigations usually started with a letter from the NYC Human Resources Administration (HRA) asking for information about your household and finances. If HRA decided that you were not eligible for Medicaid for a period of time, they would ask you to sign a contract agreeing to pay back the Medicaid “overpayment.” The overpayment is the cost of your Medicaid coverage during that time.

If you did not sign a settlement agreement, HRA would send your case to a law firm (most likely Linebarger Goggan Blair & Sampson, LLP, or Leopold Gross & Sommers PC). The law firm would then try to settle the case with you. If you did not settle the case, the law firm might have then sued you in court.

Now, in New York City, people who signed a settlement agreeing to pay back a Medicaid overpayment do not have to make any more payments on that agreement. But, if you have a court-ordered judgment, this new policy does not apply to you. You must continue to follow the judge’s order.

As a result of The Legal Aid Society’s settlement in Ciaramella v. McDonald, Medicaid dental coverage rules for root canals, crowns, dental implants, and replacement dentures have changed for Medicaid patients.

To better understand the new rules and the answers below, it may be helpful to review a chart with tooth numbers.

This guide will answer common questions about New York State’s new Medicaid pharmacy benefits program, NYRx, which took effect April 1st, 2023.

This guide will answer common questions about how to use your Medicaid to get health care services.  It will cover:

• Understanding Your Medicaid Plan
• Finding a Doctor
• Getting Care
• Appealing a Denial

A Medicaid spenddown is when your monthly income is more than the income limit for Medicaid. The difference between your income and the Medicaid limit is called a “spenddown” or a “surplus.” You also might be told you are “over-income” for Medicaid or have “excess income.”

Information about receiving a lump sum payment from Medicaid and how it may affect your eligibility or coverage.

New York and federal law requires health insurance – including Medicaid, Child Health Plus, and private insurance – to cover most court-ordered behavioral health treatment when medically necessary.

There is a lot of information about what kind of health insurance (sometimes called “health coverage,” or “coverage”) you might be eligible for depending on your immigration status. This page is intended to provide basic information to you so that you can make an informed decision about your health coverage. Because this can be complicated, if you have questions or concerns you can contact The Legal Aid Society, another legal services organization, or a trained assistor to learn about your coverage options. You should not assume that even if you are not a citizen or a green card holder (lawful permanent resident) that you are not eligible for health coverage.

In New York, regardless of your immigration status and your ability to pay, you are entitled to hospital treatment in the case of a medical emergency. There are also many ways to access affordable health care in New York City.

Medicaid is a comprehensive health insurance program for low-income people of all ages. Medicaid covers a variety of health services including home care, nursing home, dental, vision, crisis intervention, inpatient rehabilitation, outpatient services, opioid treatment (including medication-assisted treatment), and residential treatment.

In New York, coverage is available for hormone therapy (including cross-sex hormones and pubertal suppressants), surgeries, and other procedures. To receive coverage, you have to have a diagnosis of gender dysphoria and your doctor’s notification that the treatment you seek is medically necessary. The process can feel complicated and overwhelming, but you are entitled to this coverage. Here’s what you need to know.

An overpayment occurs when the Social Security Administration (SSA) states that you received more social security or SSI benefits than you were supposed to receive. Here’s what you need to know to get the benefits you deserve.

Supplemental Security Income (SSI) is a federal program that pays benefits to adults with disabilities who have limited income and resources, and who have little or no work history.

Adults with a work history might also be eligible for Social Security Disability (SSD). The Social Security Administration (SSA) runs both programs. While there are differences in the two benefits, the rules for being found “disabled” are the same for both. Learn more about eligibility and how the process works below.

Supplemental Security Income (SSI) is a federal program that pays benefits to children and adults with disabilities who have limited income and resources. Learn more about how to apply and how to appeal a denial below.