The Medicaid Unit in Ontario County is made up of several sub-units that are responsible for the myriad of programs that the New York State Department of Health has instituted over the years. The primary programs include full Medicaid which pays for all medical care and Chronic Care which pays for nursing home services. Smaller programs cover Medicare premiums, AIDS health insurance premiums, family planning services, Medicaid for the working disabled, and for pregnant women. Each program has its own eligibility criteria.

The total number of Medicaid applications registered in 2014 was 3502, a decrease of 30% below 2013. The caseloads changed as follows: Community Medicaid (+5%), Family Health Plus (-45%), SSI Medicaid (-2%), SSI Food Stamps, now known as SNAP (-1%), and Chronic Care (+0%).
In 2014 223 children transitioned from Child Health Plus to Medicaid. Children who are Medicaid eligible cannot opt to be on Child Health Plus.

The AD/DCAP Unit received 77 referrals for disability determinations for the Medicaid and Medicaid for the Working Disabled programs, of which 92% of the cases pursued were approved by the state review team. The team also assists Temporary Assistance clients in applying for SSI benefits so they can transition from the cash assistance programs to a higher level of income through Social Security’s Supplemental Security Income Program.
The Medicaid team receives applications through a variety of outside entities.

  • Outside agencies submit applications on behalf of individuals for the Medicare Savings Program.
  • The state sends the Department lists of people who may be eligible for payment of their Medicare Part B premium through Medicaid.
  • We work closely with Lifetime Care and several other area agencies to provide Medicaid coverage to pregnant women through the MOMS program.
  • The Department of Health now contracts with Clinton County DSS to process Medicaid applications for inmates of state prisons. When a Medicaid case is opened for an incarcerated Ontario County resident the case is forwarded to the district to maintain the case and activate the coverage upon release.
Anyone in receipt of Medicaid in Ontario County who does not have other health insurance is mandated to enroll in a Managed Care Plan. Four plans are now available to Ontario County residents: Excellus, MVP, Fidelis, and United Health Care. New York DOH provides an employee from Maximus to provide the required education piece for new Medicaid recipients and to assist them in selecting the managed care plan that best suits them.

Beginning January of 2014 the New York State of Health, also known as the Exchange began taking Medicaid applications for those clients that qualified under the Modified Adjusted Gross Income or MAGI budgeting process. This accounts for the decrease in applications noted above. Applicants in certain categories are now required to apply through the Exchange. Those four agencies, Thompson Health, S2AY Rural Health Network, Excellus and Fidelis that once assisted clients applying for Medicaid at the local DSS as Facilitated Enrollers are now known as Navigators, assisting clients that are required to apply through the Exchange. Applications that the Exchange deem not eligible for MAGI budgeting are returned to the local district for processing.
As of December of 2014, Ontario County began participating in the Managed Long Term Care Program. Those Services such as LTHHC and home health aides will now be provided through Fidelis or iCIRCLE providers in Ontario County. New clients in need of these services will have to enroll in one of these plans. Those clients that are currently receiving these services through the County will be phased in to either plan. Maximus assists clients in choosing a plan.
The DOH Enrollment Center had taken about 78% of the Community Medicaid under 65 renewals in 2014. While the Enrollment Center processes the renewals, the local district retains a role in these cases in forwarding information, acting as an advocate for the client, and in some cases processing renewals locally when DOH cannot process it for some reason. The role of the Department will continue to change as New York State continues their takeover of Medicaid administration.

For statistics see Annual Report 2014