Government Sponsored Insurance Programs
Mount Sinai Health System has dedicated resources to help patients apply for government-sponsored health insurance programs to pay for health care services provided by our hospitals. These programs include:
Medicaid
Medicaid is a government assistance program that offers health care coverage for low-income individuals/families of all ages. Title XIX of the Social Security Act is a Federal/State sponsored program that is designed to pay medical costs for certain designated individuals/families that happen to have low incomes or resources.
So who is eligible for Medicaid? Eligibility includes (but is not limited to) people who are aged, blind, or disabled, along with certain people in families with dependent children. Since Medicaid is a "means test" based program, applicants are required to prove their financial need to be eligible.
Medical Services Provided Under Medicaid
- Inpatient hospital services
- Outpatient hospital services
- Mental health services
- Prenatal care
- Vaccines for children
- Physician services
- Nursing facility services for persons aged 21 or older
- Family planning services and supplies
- Rural health clinic services
- Home health care for persons eligible for skilled-nursing service
- Laboratory and x-ray services
- Pediatric and family nurse practitioner services
- Nurse-midwife services
- Early and periodic screening, diagnostic, and treatment services for children under age 21
- Short term and long term nursing home coverage
You May be Eligible for Medicaid
- If you have high medical bills
- If you receive Supplemental Security Income (SSI)
- If you meet certain income, resource, age, or disability requirements
- If you are a US citizen, resident alien or otherwise qualified alien
Cost
Medicaid is a public entitlement and does not cost anything to apply. Certain eligible individuals may have income or resources that exceed the NY State Medicaid income and resource levels. Individuals who are eligible under a federal category may receive benefits via the NY State Surplus/Spend-down Program.
On-Site Application
Applications for Medicaid may be completed by visiting our Department of Financial Counseling located in our hospitals. Please see the “How to Apply for Financial Assistance Under This Policy” section of our website for details on how to contact a Financial Counselor who can assist you with a Medicaid application.
Documentation Required Completing a Medicaid Application
- Proof of identity like a birth certificate
- Proof of citizenship or alien status
- Recent paycheck stubs (if you are working)
- Proof of your income from sources like Social Security disability, Supplemental Security Income (SSI), Veteran's Benefits (VA), or retirement
- Proof of where you live, like a rent receipt, or landlord statement
Child Health Plus
Child Health Plus is an insurance program sponsored by the State of New York for children up to age 19 of families who are New York State residents, who do not qualify for Medicaid and have no other health coverage.
The program works by giving you the opportunity to have your child or children join a managed care plan. You have to select a primary care physician for your child when you join. You also want to be sure that the plan you pick works with the hospitals, clinics, and doctors that you want to use.
Medical Services Provided Under Child Health Plus
- Well child care
- Physical exams
- Immunizations
- Diagnosis and treatment of illness and injury
- X-ray and lab tests
- Emergency care
- Prescription and non-prescription drugs if ordered
- Inpatient hospital medical or surgical care
- Short term therapeutic outpatient services (chemotherapy, hemodialysis)
- Limited inpatient and outpatient treatment for alcoholism and substance abuse, and mental health
- Dental care
- Vision care
- Speech and hearing
- Durable medical equipment
- Emergency ambulance transportation to a hospital
- Hospice
Children Eligible Under Child Health Plus
- Are under age 19
- Have little or no health insurance
- Are not eligible for Medicaid
- Are New York State residents
Cost
Family size and annual income determine cost of coverage. Coverage could be absolutely free to you or you may be required to pay a minimal monthly premium. Monthly premiums vary slightly from year to year.
On-Site Enrollment
On site enrollment is available at Mount Sinai Health System hospitals in Manhattan. You can enroll on-site at Mount Sinai Beth Israel, Mount Sinai-Union Square, New York Eye and Ear Infirmary of Mount Sinai, Mount Sinai West and Mount Sinai Morningside. It is suggested that you bring documentation with you to complete a Child Health Plus enrollment application. Documentation needed is described below. To schedule an appointment for on-site enrollment, please call the appropriate contact number in the “How to Apply for Financial Assistance Under This Policy” section of the website.
Documentation Required To Complete Enrollment
- Child/children age(s) -Birth certificate; passport; hospital or religious record.
- Residence within New York State - Recent rent receipt (within the last 6 months), utility, or tax bill. You must provide proof of your physical address, not a mailing address (i.e. post office box).
- Proof of income - A written statement or copy of check or stub from your employer, person, or agency providing income. Please provide all that may apply - wages, paycheck stubs of last 4 consecutive weeks; unemployment benefit check; Social Security Award Letter (if applicable).
- Proof of other income - Any other income should be documented.
The following Hospitals participate in Child Health Plus:
Manhattan
- Mount Sinai Beth Israel
- Mount Sinai-Union Square
- New York Eye and Ear Infirmary of Mount Sinai
- Mount Sinai West
- Mount Sinai Morningside
Family Health Plus
Family Health Plus is an insurance program sponsored by the State of New York for adults 19-64 years old. You must be a New York State resident who doesn't qualify for Medicaid and has no other health coverage. Working adults must meet an income test that is slightly higher than what is allowed for Medicaid.
The program works by giving you the opportunity to join a managed care plan. You have to select a primary care physician when you join. You also want to be sure that the plan you pick works with the hospitals, clinics, and doctors that you want to use.
Medical Services Covered Under Family Health Plus
Family Health Plus provides comprehensive health insurance coverage. When you choose a health plan, you will have a regular doctor, get regular checkups and see specialists, if needed. Coverage includes:
- Physician services
- Inpatient and outpatient hospital care
- Prescription drugs and smoking cessation products
- Lab tests and x-rays
- Vision, speech, and hearing services
- Rehabilitative services (some limits apply)
- Durable medical equipment
- Emergency room and emergency ambulance services
- Behavioral health and chemical dependence services (which includes drug, alcohol, and mental health treatment - some limits apply)
- Diabetic supplies and equipment
- Hospice care
- Radiation therapy, chemotherapy, and hem dialysis
- Dental services (if offered by the health plan)
Adults Eligible to Join a Family Health Plan
- Between and including the ages of 19 and 64
- Currently are not receiving equivalent coverage
- Not eligible for Medicaid
- Are New York State residents (in most cases you must be a legal resident or Green Card holder to receive Family Health Plus)
- Meet the income requirements
Documentation Required To Complete Enrollment
- Residence within New York State - Recent rent receipt (within the last 6 months), utility, or tax bill. You must provide proof of your physical address, not a mailing address (i.e. post office box).
- Proof of income - A written statement or copy of check or stub from your employer, person, or agency providing income. Please provide all that may apply - wages, paycheck stubs of last 4 consecutive weeks, unemployment benefit check, and Social Security Award Letter (if applicable).
- Proof of other income - Any other income should be documented.
Cost
There is no cost to apply for or participate in Family Health Plus. There are no application fees and there are no co-payments or deductibles once you are enrolled. There are no sliding fees or any other cost sharing for Family Health Plus.
On-Site Enrollment
On site enrollment is available at Mount Sinai Health System hospitals in Manhattan. You can enroll on-site at Mount Sinai Beth Israel, Mount Sinai-Union Square, New York Eye and Ear Infirmary of Mount Sinai, Mount Sinai West, and Mount Sinai Morningside. It is suggested that you bring documentation with you to complete a Family Health Plus enrollment application. Documentation needed is described below. To schedule an appointment for on-site enrollment, please call the appropriate contact number in the “How to Apply for Financial Assistance Under This Policy” section of our website.
The following Hospitals participate in Family Health Plus:
Manhattan
- Mount Sinai Beth Israel
- Mount Sinai-Union Square
- New York Eye and Ear Infirmary of Mount Sinai
- Mount Sinai West
- Mount Sinai Morningside
PCAP
PCAP is a comprehensive prenatal care program that offers complete pregnancy care and other health services to women and teens who live in New York State and meet certain income guidelines (women are eligible for services up to 200% of the federal poverty level). PCAP offers routine pregnancy checkups, hospital care during pregnancy and delivery, full health care for the woman until at least two months after delivery and full health care coverage for the baby up to one year of age.
Medical Services Provided Under PCAP
- Routine pregnancy medical check-ups, lab work, and access to specialists
- Hospital care during pregnancy and delivery
- Information about pregnancy, labor and delivery
- HIV counseling and testing
- Help in applying for other programs such as WIC and low or no cost health insurance for your children and family
- Full health care for you until at least two months after delivery
- Health care for your baby for at least one year after birth
- Family planning services
You May Be Eligible for PCAP
- If you can prove your identity (no citizenship or resident alien requirement)
- If you provide proof of income (a resource test is not applied) or support
- If you provide proof of household residence
- If you provide proof of EDC/pregnancy
Cost
PCAP is a public entitlement and does not cost anything to apply.
On-Site Application
Applications for PCAP may be completed by visiting our Department of Financial Counseling located throughout Mount Sinai Beth Israel, Mount Sinai Morningside, and Mount Sinai-Union Square. See contact information below for details.
Documentation Required To Complete a PCAP Application
- Proof of identity: for example, a birth certificate
- Recent paycheck stubs (if you are working) or proof of support by a relative or friend
- Proof of where you live: for example, a rent receipt/lease or landlord statement
- Proof of your pregnancy
Contact Numbers for PCAP
Manhattan
- Mount Sinai-Union Square 212-844-8610
- Mount Sinai West 212-523-7868
- Mount Sinai Morningside 212-523-2575