Eligibility and Enrollment

Find out if you're eligible. Then learn how to enroll.

Eligibility and EnrollmentHelping you determine your eligibility for one of our programs is our goal. The questions and answers below address topics that can help you learn what you need to know about qualifying for and enrolling in one of our programs.

How do I know if I'm eligible?

Eligibility requirements for these programs are established by New York State and include household income (not necessarily how much money you have in the bank), residency, family size and age, as well as your citizenship or immigration status and whether you already have other insurance. The programs are available in all five boroughs of New York City, as well as in Nassau, Suffolk and Westchester counties. To find out if you are eligible, you can enter your information in our easy-to-use Program Finder Tool, or call Customer Service at 1-855-283-2146. You can also visit the NY State of Health Marketplace online at www.nystateofhealth.ny.gov or call 1-855-355-5777.

Will everyone in my family be eligible for the same program?

Not necessarily. Because eligibility for the Medicaid and Child Health Plus (CHPlus) programs is based on more than just family size and income, it is possible that members in the same family will be eligible for different programs. For example, in a family with three children, it is possible that the parents and the youngest child will be eligible for Medicaid and the other children will be eligible for CHPlus.. This will be because of differences in the age, immigration/citizenship status or other eligibility requirements of different family members.

How do I apply?

If you already have regular Medicaid coverage and want to enroll in a EmblemHealth or in another managed care plan, call New York Medicaid Choice at 1-800-505-5678.

If you are already enrolled in a Medicaid Managed Care plan but would like to change health plans:
Call New York Medicaid CHOICE at 1-800-505-5678 and ask to be switched to the Medicaid Managed Care plan of your choice.

If you have no health care coverage and would like to apply for Medicaid or Child Health Plus coverage for you and your family, you must apply through the NY York State of Health Marketplace online at www.nystateofhealth.ny.gov or call 1-855-355-5777.

We suggest that you meet with an EmblemHealth Marketplace Facilitated Enroller (FE) if you are uninsured or would like assistance in renewing your eligibility for a program. FEs are conveniently located in a variety of community sites and can assist you with the online application and answer any questions you may have. To make an appointment with an FE, call toll-free at 1-800-542-2412 (Monday through Friday, 8 am to 8 pm). Find the FE location closest to you.

Once I apply, how long will it take to receive coverage?

If you already have Medicaid and are selecting or changing health plans through New York Medicaid Choice and:

  • You request the change before the 20th day of the month, the change will be effective on the first day of the next month.
  • You request the change after the 20th day of the month, the change will be effective on the first day of the second following month.

If you are uninsured and you completed an application on the NY State of Health Marketplace, and you or your child(ren) are found eligible for Medicaid or Child Health Plus and:

  • Your completed application is processed before the 15th day of the month, your coverage may begin on the first day of the next month.
  • Your completed application is processed after the 15th day of the month, your coverage may begin on the first day of the second following month.

Also note that if a Child Health Plus premium payment is required, the payment must be received before your child (ren) can obtain coverage.

If I join a health plan with EmblemHealth, will EmblemHealth help me understand it?

Yes. Shortly after you are successfully enrolled, we will:

  • Send you an EmblemHealth member card.
  • Call to welcome you to EmblemHealth and give you important information to help you select a primary care doctor (if you haven't already done so) and answer any questions you may have.
  • Send you a New Member Welcome Kit with a Member Handbook that tells you about your health care coverage and how to use it.

We will also send you member newsletters with updates on benefit and service changes, as well as tips about staying healthy.