Sep 032023
 

GIS 23 MA/17, which is dated 08/29/2023, advises that there is a new Medicaid application form.

The new version of the Access NY Health Care Application will show this at the bottom of each page: (1/23).

The new version of the form is an attachment to the GIS.

It also may be found by going to: http://www.health.ny.gov/forms/doh-4220.pdf

If that link stops working, the form may be found on the New York State Department of Health website.

Go to www.health.ny.gov

Click on: Individuals/Families

Click on: Health Topics A to Z

Click on: the letter M

Click on: Medicaid

Click on: How to Apply (this will be on the left side of the screen)

Scroll down to: Medicaid Application for Non-MAGI Eligibility Group

Click on: DOH-4220

Posted 09/03/2023

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