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Questions About Medicaid and/or Family Health Plus

 


Question: Does the Facilitated Enroller decide if I am eligible?

Answer: No. A Facilitated Enroller's role is to help you fill out the application. The final decision about your eligibility for coverage (often called "a determination") will be made by staff at the Department of Human Services (DHS).

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Question: Will I need to provide additional information after my application is submitted to the Department of Human Services?

Answer: It is possible that once your application is reviewed at DHS, the worker reviewing the application will request additional information. If this happens, you will need to send this information directly to DHS by the deadline that you are given. Your application may be denied if you do not provide DHS with this information.

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Question: How will I know that the Department of Human Services has received my application?

Answer: You can expect to receive a letter from DHS informing you that your application for Medical Assistance was received and has been sent to a team for review. Be sure to keep this letter.  If you receive notification to go to DHS for an appointment, please call your Facilitated Enroller as another appointment is not required. DO NOT IGNORE REQUESTS FROM DHS FOR ADDITIONAL INFORMATION.

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Question: How long will it take for a decision about my health insurance coverage?

Answer: You can expect an eligibility determination to take anywhere from 30 to 45 business days. Please carefully read the Notice of Decision you receive in the mail from DHS, and keep this letter for an entire year. If you have not heard about your eligibility determination at the end of 45 days, call the team listed on the letter you received from the Department of Human Services.

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Question: What happens if I am eligible for Medicaid?

Answer: If you or your family member qualifies for Medicaid, you can expect to be on Medicaid fee-for-service until you are transferred to a Medicaid Managed Care Plan (Blue Choice Option, Fidelis Care Option or MVP Option). This may take up to 2 or 3 months.

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Question: Will I be responsible for paying my medical bill if my health care provider does NOT accept Medicaid fee-for-service or Medicaid Managed Care Plan?

Answer: Yes. It is your responsibility to ask your doctors, dentists, therapists, etc., if they accept Medicaid fee-for-service or Medicaid Managed Care Plan when you schedule a time to be seen. If they do not accept Medicaid, and you receive care from them, you will be responsible for the bill. You will need to find a different doctor, dentist, therapist, etc. who does accept Medicaid.

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Question: Will I receive a Medicaid benefit card?

Answer: Yes.

  • If you are accepted for Medicaid… you should receive a plastic benefit card in the mail for each child/adult who is eligible. If you do not receive a card in the mail within a week of receiving the Notice of Decision, you need to contact the worker listed on the notice.
  • Once you have been transferred to a Managed Care plan, you will receive a paper card from Excellus Blue Cross Blue Shield, Fidelis Care or MVP. You will need to use both cards, so do not throw either card away!
  • If you are accepted for Family Health Plus you will receive a plastic Medicaid benefit card for prescriptions only and a paper card from the Managed Care Plan (Excellus Blue Cross Blue Shield, Fidelis Care or MVP) possibly within 45 days.
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Question: Who can help with questions once my application has been submitted?

Answer: All questions should be directed to your Department of Human Services worker. That person's name and phone # will be listed on your Notice of Decision.

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Question: What if my income or household composition changes after I receive coverage?

Answer: If your income or household composition changes after your coverage has begun, you must to contact your worker within 10 days.

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Facilitated Enrollment

 

Have A Question?

Call 585.613.7662 for a Facilitated Enroller in your area.

If you are 65 and older and in need of health insurance, the Department of Human Services can help:

Monroe County residents call 585.753.6960

Livingston County residents call 585.243.7300

Certain income guidelines apply. Must be a resident of NY State