When we think of government programs like Medicare, Social Security, and Medicaid, with typically think of older adults. But children can also be eligible for Medicaid benefits in New York and across the nation. The specific eligibility criteria can vary from state to state, but generally, children from low-income families can qualify for Medicaid.

A child’s eligibility does not depend on family members receiving benefits, children in New York may still qualify for additional support. Your family’s monthly income and family size will determine whether your child is eligible and to what extent you’ll be expected to pay for services. To determine if a child is eligible for Medicaid, parents or guardians can visit the healthcare.gov website or contact their state’s Medicaid office.

Eligibility in New York

In New York, the criteria for children to receive Medicaid include several factors such as age, family income, and residency status. Here are the key eligibility criteria:

• Age – Children under the age of 19 can be eligible for Medicaid.
• Income – The family’s income must fall within certain limits, which are based on the Federal Poverty Level (FPL). For children, these limits are generally higher than for adults to ensure broader coverage.
• Residency – The child must be a resident of New York State.
• Citizenship/Immigration Status – The child must be a U.S. citizen, national, or have satisfactory immigration status.
• Household Size – Eligibility is determined by the total income of the household and the number of people living in the household.

* A child may be eligible for Medicaid is their status as a Social Security beneficiary. Children with disabilities who receive supplemental security income (SSI) payments can receive Medicaid coverage in most states since eligibility for SSI also means the child comes from a low-income household.

Children’s Medicaid Income Eligibility

Income levels and cutoffs depend not only on the amount you make but also on how many people live in your household. Below is a breakdown of the monthly income limits that determine Medicaid eligibility. Notice that each household size has its own respective income limit.

New York Children’s Medicaid Income Eligibility Source: New York Department of Health
Age Categories	Monthly Income by Family Size*								For each additional person, add:
	1	2	3	4	5	6	7	8
Children Under 1 Year; Pregnant Women*	$2,710	$3,665`	$4,630	$5,575	$6,531	$7,486	$8,441	$9,396	$956
Children 1-18 Years	$1,872	$2,531	$3,191	$3,850	$4,510	$5,170	$5,829	$6,489	$660

*Pregnant women should also be considered in family size, as total household size calculations include all expected children.

How to Apply for NY Medicaid

If you meet the criteria above, you are eligible and can move forward with your Medicaid application. It’s common for Medicaid applications to get rejected due to incomplete data. Before submitting your application or visiting an office to get assistance with your application, make sure you have all of the necessary documentation:

• Birth certificate
• Proof of citizenship
• Proof of income (Tax return, paystubs, Social Security, or any other form of income source)
• Copies of bank statements for proof of assets/finances.
• Proof of residences
• Proof of other insurance (if applicable)

You can apply for NY Medicaid in the following ways:

• Through NY State of Health
• Through a Managed Care Organization (MCO)
• Call the Medicaid Helpline (800) 541-2831

Through your Local Department of Social Services Office

What Services does Medicaid Offer?

Medicaid provides comprehensive healthcare coverage, including doctor visits, hospital care, prescription drugs, preventive services, and more. States have some flexibility in determining the specific services covered under their Medicaid programs. For some pregnant women, services may be limited to perinatal care if their incomes are too high to qualify for full Medicaid coverage.

Medicaid offers a full range of health services for eligible persons including:

• All regular medical checkups and needed follow-up care.
• Immunizations.
• Doctor and clinic visits.
• Medicine.
• Medical supplies.
• Medical equipment and appliances (wheelchairs, etc.).
• Lab tests and x-rays.
• Eye care and eye glasses.
• Emergency care.
• Dental care.
• Nursing home care.
• Emergency ambulance transportation to a hospital.
• Hospital stays.

For children birth to 21 years old, Medicaid offers the Child/Teen Health Program (C/THP), which provides the services listed above for all Medicaid recipients. C/THP places an emphasis on preventive care and treatment. For example, Medicaid requires that all children be screened with a blood lead test at one and two years of age. C/THP is available from fee-for-service healthcare providers. Also, all managed care plans must offer C/THP to Medicaid recipients under 21 years of age who are enrolled in their plan.

Child Health Plus and Family Health Plus provide services to eligible children and adults, respectively, through managed care plans.

Child Health Resources in New York

If you’re looking to learn more about New York State Medicaid for children or state programs that can help you cover the cost of health care, the following resources may be useful.

NYS Provider & Health Plan Look-Up: Here, you can look up which providers — both doctors and hospitals — are included in your Medicaid health plan.

NY State of Health: You can find specific enrollment instructions for Child Health Plus by visiting the New York State of Health, a health insurance marketplace hosted by the official NY.gov website.

Local Department of Social Services Offices (Children’s Medicaid): Use this list to find the address and contact information for your local Social Services office, where you can find more information about Medicaid and other government programs. Any questions or concerns you may have about your child’s health insurance can be directed here, too.

NY State of Health Instant Quotes: This tool from the State of Health allows you to view which health insurance options are available to you. You can also use it to see if your income qualifies your child for Medicaid.