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| Home > Members &
Applicants > Eligibility Information |
Medicaid Managed Care
MetroPlus Medicaid Managed Care plan is available to people less than 65 years of age who have or are
eligible for Medicaid. Medicaid managed care is available to those who qualify or have:
- Temporary Assistance to Needy Families (TANF)
- Medicaid only (TANF and MA-ADC or MA-HR)
- SSI
Medicaid Managed Care offers benefits, such as:
- Regular check-ups and office visits with your own PCP
- 24-hour, 7 days a week emergency health hotline
- Referrals to specialists
- Well-baby and well-child care visits
- Vision and hearing examinations
- Lab tests and x-rays
- Inpatient and out-patient hospital care
Am I eligible?
Where can I enroll?
What documents do I need to enroll?
I want someone to contact me about enrolling
CHPlus A, PCAP and Medicaid Income Eligibility Levels (revised 1/07)
| Monthly Income for Family Size |
| Age Categories for Children |
1 |
2 |
3 |
4 |
5 |
6 |
Additional Person,
Add: |
Children Under 1 Year;
Pregnant Women* |
$1,702 |
$2,282 |
$2,862 |
$3,442 |
$4,022 |
$4,602 |
$580 |
| Children 1-5 Years |
$1,132 |
$1,518 |
$1,904 |
$2,289 |
$2,675 |
$3,061 |
$386 |
| Children 6-18 Years |
$851 |
$1,141 |
$1,431 |
$1,721 |
$2,011 |
$2,301 |
$290 |
Children 19-20 Years
Parents/Disabled Indiv
|
$700 |
$900 |
$1,100 |
$1,109 |
$1,117 |
$1,134 |
$142 |
| * Pregnant Women count as 2 people
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Child Health Plus
Child Health Plus B is New York State's health insurance program for children, residing in New York State,
under 19 years old who are not eligible for Child Health Plus A (Children's Medicaid) and have little or
no health insurance.
Child Health Plus offers benefits, such as:
- Regular check-ups with your own PCP
- 24-hour, seven-day-a-week emergency hotline
- Referrals to specialist
- In-patient and out-patient hospital care
- Lab tests and x-rays
- Routine dental care
- Eyeglasses and much more
Child Health Plus is free for some families. Depending on your income, some families may have to pay a
small monthly fee of $9 or $15 per child per month with a family maximum of $27 or $45. Families with
higher incomes can enroll their children in Child Health Plus and pay the full premium of $112.01.
Am I eligible?
Where can I enroll?
What documents do I need to enroll?
What are the income/premium requirements?
I want someone to contact me about enrolling
Child Health Plus B Premium Levels Chart (revised 4/07)
| Monthly Income for Family Size* |
| PREMIUM CATEGORIES |
1 |
2 |
3 |
4 |
5 |
6 |
Additional Person,
Add: |
| Free Insurance |
$1,361 |
$1,825 |
$2,289 |
$2,753 |
$3,217 |
$3,681 |
$464 |
$9 Per Child Per Month
(Maximum of $27 per family) |
$1,889 |
$2,533 |
$3,177 |
$3,821 |
$4,465 |
$5,108 |
$644 |
$15 Per Child Per Month
(Maximum of $45 per family) |
$2,128 |
$2,853 |
$3,578 |
$4,303 |
$5,028 |
$5,753 |
$725 |
| Full Premium Per Child Per Month |
Over
$2,128 |
Over
$2,853 |
Over
$3,578 |
Over
$4,303 |
Over
$5,028 |
Over
$5,753 |
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* Pregnant Women count as two
Family Health Plus
Family Health Plus is New York State's health insurance program for adults, aged 19-64, who are a US
citizen or fall under one of many immigration categories, not eligible for Medicaid and do not have
private health insurance.
Family Health Plus offers benefits, such as,
- Regular check-ups with your own PCP
- Hospital and emergency care
- Prescription drugs
- Eye and dental care
- Labs, x-rays and much more
Family Health Plus is FREE for those who meet certain income requirements
| Family Size |
MAXIMUM GROSS INCOME (Family) |
| Monthly Income |
| Single Adult |
$851 |
| Married Couple with No Children |
$1,141 |
| Married Couple with 1 Child * |
$1,277 |
| Married Couple with 2 Children * |
$1,712 |
| Married Couple with 3 Children * |
$2,147 |
| Married Couple with 4 Children * |
$2,582 |
| Married Couple with 5 Children * |
$3,017 |
| Married Couple with 6 Children * |
$3,452 |
| * Parent living with at least one child under 21 |
|
Chart is effective 1/2007 and subject to annual income updates.
Am I eligible?
Where can I enroll?
What documents do I need to enroll?
I want someone to contact me about enrolling
Partnership in Care
MetroPlus Partnership in Care program is open to people with Medicaid who are HIV positive or have AIDS
and live in Brooklyn, Queens, the Bronx or Manhattan. This program provides a team approach to caring
for individuals with HIV/AIDS. The team includes HIV Specialists as PCPs, a social worker, nutritionist
and a Nurse Case Manager.
Partnership in Care offers benefits, such as:
- Specialists in HIV care as PCPs
- Treatment adherence services
- HIV prevention and risk reduction education
- Regular check-ups with your PCP
- Case Management
- Nutritional Assessment and Guidance
- Individualized Care Planning
- Maternity and child care including care for infected and uninfected children
- Referrals to specialist
- In-patient and out-patient hospital care
- Lab tests and x-rays
- Home care services
- Mental health and substance abuse services
Where can I enroll?
What documents do I need to enroll?
I want someone to contact me about enrolling
MetroPlus Gold - For HHC Employees
This program is available only to employees of the New York City Health and Hospitals Corporation (HHC) and their dependents.
They can enroll at the time they are hired by HHC or during the fall Open Enrollment period.
Check with your Human Resources department.
Basic coverage is free. There are no claim forms, paperwork or bills.
MetroPlus Gold offers benefits, such as:
- Regular visits with a doctor you choose—from a vast network of physicians in the community and at major health care sites
- Referrals to specialists
- Maternity and newborn care
- Well baby care and immunizations
- Medically necessary in-patient hospital care including room and board, intensive care, physician and surgical services
- Special health education and care programs. You can join MetroMom, AsthmaPlus, DiabetesPlus and get help with smoking cessation, weight control and other health concerns
- A 24/7 health care hotline—so you are never out of touch
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