Medicaid Services in Syracuse
Medicaid guide for residents of Onondaga County
What is Medicaid?
Medicaid is a public program that provides medical care coverage for qualifying residents. The Federal Department of Health and Human Services (DHHS) oversees the program, but each state is responsible for developing and managing their own Medicaid State Plan. The New York State Department of Health runs the program for residents of New York State. Medicaid plans cover a wide range of services for people of all ages.
Do I qualify for Medicaid in New York State?
People who receive Supplemental Security Income (SSI), have high medical bills, or are considered low-income, may qualify for Medicaid coverage. This includes adults, seniors over 65, infants, children, pregnant women, people with disabilities, and those with an immediate need for care.
Many people qualify based on their financial need. These persons are called MAGI applicants (Modified Adjusted Gross Income). The State will consider the income and number of people in the household to determine financial eligibility. You can find a chart that shows the current income limits by clicking here and choosing the “How do I know if my income and resources qualify me for Medicaid?” tab from the list.
Non-MAGI programs are available to seniors 65 and older, disabled people who do not meet the MAGI requirements, and those who live in homes ran by the Department of Social Services or Office of Mental Health. There are also programs available for COBRA coverage, AIDS-related care, and cancer treatments.
How do I apply for Medicaid in Syracuse, NY?
If you live in Syracuse, New York and you want to apply for Medicaid benefits or learn more about the programs available to you can call your local Medicaid Community Unit at (315) 435-2928 between 8:00 am and 4:00 pm, Monday through Friday. The Medicaid office is located in the Onondaga County Office Building, 7th Floor, 600 South State Street, Syracuse, NY 13202.
If you are in one of the following categories and will apply based on financial need (MAGI), you may apply through the NY State of Health Official Health Plan Marketplace by calling (855) 355-5777 or visiting their website at nystateofhealth.ny.gov:
· Adults aged 19-64 who are not pregnant and do not qualify for Medicare
· Pregnant women and infants
· Parents of minor children aged 1-18
· Adult caretaker relatives and guardians
The following people must apply in person with Onondaga County Department of Social Services:
- Seniors aged 65 and older
- Blind or disabled persons
- Those who need community-based long-term care services (CBLTC) or treatment in centers operated by the Office of Mental Health (OMH)
- People interested in the Medicare Savings Program (MSP) or Medicaid buy-in for Working People with Disabilities enrollees (MBI-WPD)
- Pregnant women who have received prenatal care from a provider based on Presumptive Eligibility (PE) that has yet to be processed by the Onondaga County Department of Social Services.
*It is recommended that you call the office first at (315) 435-2928 to make an appointment and receive instructions about what documents you may need to bring with you
Pregnant women can apply for prenatal care in Syracuse, NY at any of the following locations:
- Family Planning (315) 435-3295
- Planned Parenthood (315) 475-5540
- St. Joseph's Maternal Child Health Center/St. Joseph's family medicine (315) 448-6146
- Syracuse Community Health Center (315) 476-7921 extension 2327
- UHCC/Womens Health Care Services (315) 464-5210
Does Medicaid cost me anything?
Some services may include a small copay, such as clinic visits, laboratory tests, medical supplies, overnight hospital stays, emergency room visits for non–emergency services, prescription drugs, and over the counter (OTC) drugs.
Certain people are exempt from copays entirely, including anyone who opts for a Managed Care Plan. Talk to your caseworker for more details about copays specific to you.
There is an annual limit of $200 for out of pocket copayments, after which you will not need to pay any more copays that year. No provider can refuse treatment for inability to pay and must bill you for unpaid copays if needed.
What types of services are covered by Medicaid?
Medicaid covers a wide range of medical care services. A few of the most common services in Syracuse, NY are emergency hospital care, ambulance transportation, family planning services, smoking cessation programs, and child/teen health care. Read on for more information about these coverages.
Emergency Hospital Care
Medicaid will cover emergency hospital visits, though you may be responsible for a copay of $3.00 per visit. If you are admitted overnight, you may be responsible to pay $25.00 per night. All hospital emergency rooms will accept Medicaid coverage and you may choose whichever one you prefer. (If you are transported by ambulance, the medical staff may choose the hospital based on your condition.)
24-hour emergency rooms in Syracuse, NY include:
- Upstate University Hospital at 750 E Adams St. or The Community Campus at 4900 Broad Rd. (315) 492-5011
- Crouse Hospital at 736 Irving Ave. (315) 470-7111
- St. Joseph’s Hospital at 301 Prospect Ave. (315) 448-5111, which features an emergency psychiatry department for mental health care.
- Children’s Hospital at One Children’s Circle (315) 464-5540, for child specific care.
Urgent Care Centers in Syracuse, NY that accept Medicaid
When you have a non-emergency situation that needs immediate care like an ear infection or sprained ankle, an urgent care center can provide faster service and leaves hospital facilities open for people with life-threatening emergencies.
· WellNow Urgent Care accepts Medicaid coverage. Contact the location nearest you for hours and information.
· Upstate Golisano Pediatric Urgent Care, (315) 492-5011 at the Upstate University Hospital Community Campus 4900 Broad Rd., provides non-emergency care for children from birth until age 21. They are open every day of the year until 10:00 pm (except Christmas Eve, Christmas Day, and New Year’s Day when they are open from noon-5:00 pm).
Ambulance & Medical Transportation
If you need transportation to the emergency room or medical appointments, Medicaid will cover the cost.
For emergencies, dial 911 and the operator will send an ambulance that can reach you the soonest. The main ambulance companies in the Syracuse area are TLC Ambulance Services, American Medical Response of CNY, and A&E Transport Services, Inc.
For non-emergency medical care, like trips to doctor’s appointments, Medicaid partners with Medical Answering Service to coordinate rides. Residents of Onondaga County can reach them by calling 1-855-852-3287 or visiting their website at medanswering.com.
Medicaid also provides reimbursement for public transportation costs and mileage for personal vehicles. Talk to your caseworker for instructions on how to receive this benefit.
Family Planning Services
The Family Planning Benefit Program (FPBP) is available to teens, women, and men who need family planning and sexual health services but do not qualify for Medicaid. Services include birth control, preventative care, testing and screening, counseling, and more.
For current income limits and more info on how to apply, you can visit the NYS Department of Health website or call 1–800–541–2831. You may also visit any of the participating clinics listed below:
- Planned Parenthood of Central and Western New York, 1120 East Genesee Street, Syracuse 13210 Phone: 315-475-5540
- Syracuse Model Neighborhood/FP Onondaga County HD, 113 East Taft Road, North Syracuse 1321 Phone: 315-435-3295
- Syracuse Model Neighborhood/FP Onondaga County HD: Teen Clinic at the Dr. William Harris Health Center, 301 Slocum Avenue, Syracuse 13204 Phone: 315-435-3295
Trying to quit smoking? Good for you! Medicaid will cover the cost of any FDA approved medication that is prescribed by your doctor. Talk to your primary care provider to discuss your options and don’t forget to check out the local quit smoking programs in Syracuse, NY that offer tips, tricks, and support:
Tobacco Free for Life; Upstate's smoking and vaping cessation classes presented by Upstate Medical University Hospital
HealthLink, 6333 Rt 298, East Syracuse, NY 13057
Phone: (800) 464-8668
Alternate Phone: (315) 464-3519
American Lung Association "Freedom From Smoking"; Transitional Services
420 E. Genesee Street, Syracuse, NY 13202
Phone: (315) 218-0850
Information for everyone is available by calling 1-866-NY-QUITS (1-866-697-8487) or by visiting nysmokefree.com
Child/Teen Health Program
Children under the age of 19 who are residents of New York State may qualify for free or reduced-cost medical coverage under Children’s Medicaid or Child Health Plus. You can see the current income and cost guidelines by clicking here.
Both programs will cover most of your child’s medical needs including well-visits, dental, vision, immunizations, emergency care, speech therapy, mental health services, prescription drugs, lab tests, and so much more.
You can apply online at the NYS marketplace or by calling 1-800-698-4KIDS (1-800-698-4543) or get local assistance in Onondaga County at The Salvation Army (315) 479-1155 or the Medicaid Community Unit at the Onondaga County Department of Social Services (315) 435-2928.
Are there other medical and social services available in Syracuse, NY?
Yes. Medicaid offers a huge variety of services designed to help people get the healthcare services they need. You can find out more by visiting health.ny.gov or contacting the Onondaga Department of Social Services.