Medicaid in Monroe County
In Monroe County, Medicaid is administered by the Financial Assistance Division (a part of the New York Department of Human Services), the Social Security Administration, and the New York State Department of Health. Each is responsible for managing the Medicaid program for a particular population of people depending on their needs. For example, Medicaid that is administered for prenatal care and home care services is administered by the New York State Department of Health while Medicaid for nursing home care is administered by the Financial Assistance Division. Medicaid for disabled persons is administered by the Social Security Administration. The reason why you’re applying for Medicaid may therefore dictate which location to call or visit with questions.
The Financial Assistance government division is responsible for the provision of a number of aid programs including Temporary Assistance, the Supplemental Nutrition Assistance Program (SNAP), and Child Support Enforcement and Day Care subsidies. Individuals who qualify for Medicaid may also qualify for other types of government assistance, but each financial support program is guided by its own set of rules and regulations. The NYS Department of Health is responsible for an entirely different set of aid programs that may, some cases, be relevant to those who are in need of health coverage. Work incentive programs and other relevant assistance for disabled individuals is also available through the Social Security Administration. Questions regarding eligibility for Medicaid and other, additional financial support or resource opportunities and assistance in Monroe County are often dependent on the specifics of the situation. Inquiries should be made at the proper office.
What services does Medicaid provide for residents in Monroe County?
In Monroe County, Medicaid health care coverage provides the following services:
● Coverage for eligible individuals residing in a nursing home or long-term care-type of setting. Eligible individuals are those who are low-income, aging, or disabled and unable to afford to pay for their own long-term health care needs. A means test that reviews the previous five years of financial transactions is administered to review the individual’s resources and income as well as their spouse’s income and resources (in applicable cases) to make a final determination.
● Dental, vision, and auditory care are covered for Medicaid recipients so long at the beneficiaries visit a Medicaid-approved medical practitioner.
● Children’s Medicaid is available to Monroe County residents through New York State. This state-run program is administered through the New York Department of Health and is offered along with Child Health Plus, another health insurance plan available to eligible families. Both Child Health Plus and Children’s Medicaid are offered through providers located throughout the state.
● Medicaid home care services are available through the New York State Department of Health. Home care services allow Medicaid recipients to stay at home while receiving care, a less expensive alternative to a nursing home care setting. For eligible individuals, Medicaid covers the cost of an assisted living program, a personal care attendant, housekeeping, home health aide, or a personal emergency response system.
● The Consumer Directed Personal Assistance Program (CDPAP) is covered by Medicaid home care services. CDPAP is a Medicaid-funded program that allows consumers to seek out their own home care aides or skilled nurses. These aides or nurses may be friends or family members of the consumer and they must be managed either by the consumer him or herself, or by a designated representative.
● Medicaid is available for prenatal care for qualifying individuals.
● Medicaid is available to disabled individuals who are unable to work.
● A Medicaid Buy-In Program is also available for residents of Monroe County who are disabled but able to work and able to earn more than the allowable limit for regular Medicaid.
How do I apply for Medicaid in Monroe County?
It is possible to apply for Medicaid by visiting the appropriate office in person or by calling for an application. In some cases, it is possible to apply online applications.
Applicants who are not disabled and who are under age 65 and not disabled can go to the Health Benefit Exchange to apply for coverage. Applicants who are over age 65 or disabled can call (855) 355-5777 for help applying via telephone.
A Medicaid application can be requested by telephone by calling (585) 753-6960.
For Medicaid managed care programs, applicants can call New York Medicaid CHOICE (585) 753-6702 or 1-(800) 505-5678 to ask for information over the telephone.
Applications for Chronic Care Medicaid are available in waiting rooms at the Monroe County Department of Human Services at 691 St. Paul Street or 111 Westfall Road. Or applicants can call to request an application by telephone at (585) 753-6960.
To apply for Children’s Medicaid or inquire about the Child Health Plus program, call 1-800-698-4543. The hearing impaired can call this TTY number: 1-877-898-5849.
Applicants for Medicaid home care services can call the New York State Department of Health at (585) 753-6445. For information about the Consumer Direct Personal Assistance Program or Personal Care Aide Program, call (585) 753-6445.
Women who wish to apply for Medicaid to cover prenatal care can go in person to any of the following locations, or call for information via telephone:
Genesee Health Services / RGH
220 Alexander St Suite 603
Rochester, NY 14607
293 Upper Falls Rd.
Rochester, NY 14605
1000 South Ave.
Rochester, NY 14620
1415 Portland Ave.
Rochester, NY 14621
601 Elmwood Ave.
Rochester, NY 14642
480 Genesee St.
Rochester, NY 14611
(585) 436–3040 x1765
Unity Health Systems
89 Genesee St.
Rochester, NY 14611
Medicaid Transportation Companies That Service Monroe County
There are a number of companies in Monroe County that provide transportation services such as buses, taxis, and ambulance services to Medicaid recipients. For those who are eligible, Medicaid covers the cost of emergency medical transportation. Emergencies involve urgent medical needs (e.g. a heart attack or a car accident). No pre-approval is necessary for Medicaid to cover emergency transportation.
For day-to-day needs such as transportation to doctor’s appointments, the hospital, or another Medicaid-approved medical office, it is sometimes possible to get Medicaid reimbursement. This type of coverage is known as “non-emergency medical transportation”. Those who do not have a car that works or a driver’s license and those who are not able to travel or ride alone due to a disability may be able to receive coverage for non-emergency medical transportation. Pre-approval may be required from the state of New York to qualify for transportation services.
In Monroe County, Medicaid recipients can call Medical Answering Services (MAS) to arrange transportation through a participating Medicaid transportation company or recipients can call and schedule transportation directly with a company listed below. Some New York Medicaid transportation companies require Medicaid recipients to contact MAS rather than booking directly with them.
Transportation companies transport Medicaid recipients who can walk, those who are in a wheelchair, and even individuals who are bed-bound. Below are Medicaid transportation providers in Monroe County:
(585) 288-1700 or (585) 654-0200
(585) 201-6551 or (315) 395-9845
Relax and Ride Transportation
(585) 730-8720 or (585) 738-3743
(585) 427-7330 or (585) 415-9589
If the patient requires the use of an ambulance to go to a hospital in a non-emergency situation, the Medicaid recipient or a representative should contact the Medicaid coverage provider to make sure that the trip will be covered.
(585) 546-2525 or (585) 777-7777
(585) 370-2781 or (585) 394-5860
Doctors That Accept Medicaid in Monroe County
Medicaid is a managed care health insurance program that is managed by a system that keeps the cost, quality, and provision accessible to the enrolled members. When an applicant enrolls in the Medicaid managed care plan, they typically select a Primary Care Practitioner (PCP) to function as their regular, day-to-day doctor. This doctor is responsible for creating a coordinated health plan for the applicant. They’ll refer the applicant to other providers and specialists who can perform necessary procedures for the patient by using the network’s professionals and hospitals.
For services that are covered by this managed care plan, Medicaid pays health care providers directly so enrollees don’t have to pay out-of-pocket.
Below are doctors in Monroe County, NY who accept Medicaid:
1425 Portland Ave. Box 287
Rochester, NY 14621
1415 Portland Ave. Ste 225
Rochester, NY 14621
Fatma Akmese, MD
293 Upper Falls Blvd.
Rochester, NY 14605
Amy Chao, MD
50 Middle Rd.
Henrietta, NY 14467
Tiffany J. Algarin, DO
500 Island Cottage Rd.
Rochester, NY 14612
Jacques Stanley Cayo, MD
1425 Portland Ave Box 305
Rochester, NY 14621
The CDPAP (Consumer Direct Personal Assistance Program) allows consumers themselves to find, hire, and then direct their own home care aides. Family and friends can be hired as home care assistants and be paid for their services through CDPAP.
To be eligible for CDPAP, consumers must be in need of assistance with their day-to-day activities (known as Activities of Daily Living) and/or skilled nursing care. Individuals who are eligible for Medicaid are also eligible for CDPAP, but in order to qualify for it, the consumer or a designated representative acting on their behalf must be capable of and willing to direct the home care according to the CDPAP requirements. Family members or friends may be employed by this program, but they must be managed either by the consumer or by the consumer’s representative.
Location of Medicaid Office in Monroe County
Administration of the Medicaid program in Monroe County takes place at the Rochester Medicaid office. Food stamps and welfare are also managed at this location.
150 Wakefield Street, Suite 22
Rochester, NH 03867
(603) 332-9120; (800) 862-5300
TDD Access Relay: (800) 735-2964
Fax: (603) 335-5993