Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York

Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York

What Is Form DOH-4220?

This is a legal form that was released by the New York State Department of Health - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is DOH-4220?
A: DOH-4220 is the Medicaid Application for Non-magi Eligibility Group.

Q: Who can use DOH-4220?
A: DOH-4220 can be used by individuals who are applying for Medicaid under the Non-magi Eligibility Group.

Q: What is the Non-magi Eligibility Group?
A: The Non-magi Eligibility Group includes individuals who do not qualify for Medicaid based on Modified Adjusted Gross Income (MAGI) guidelines.

Q: What information is required on DOH-4220?
A: DOH-4220 requires personal and financial information, such as income, assets, household composition, and medical expenses.

Q: Is there a fee to submit DOH-4220?
A: No, there is no fee to submit DOH-4220.

Q: What happens after submitting DOH-4220?
A: After submitting DOH-4220, your application will be reviewed by the Medicaid agency and you will be notified of your eligibility status.

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Form Details:

  • Released on August 1, 2021;
  • The latest edition provided by the New York State Department of Health;
  • Easy to use and ready to print;
  • Available in Haitian Creole;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DOH-4220 by clicking the link below or browse more documents and templates provided by the New York State Department of Health.

Download Form DOH-4220 Medicaid Application for Non-magi Eligibility Group - New York

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