Child Health Plus

Printing and Mailing Your Access NY Health Care Application Form

If you can view the Adobe Portable Document Format (PDF) version of the application and you can print a copy of the application that looks exactly like the one you see on-screen, you can use that copy to apply for Child Health Plus by mail. (If not, you can call 1-800-698-4KIDS, or 1-800-698-4543, to request a copy. If you are hearing impaired, call the TTY number, 1-877-898-5849.)

If you would like help completing your application, you should contact a facilitated enroller. In general, we recommend that you see an enroller if your income is less than $2,000 a month - so they can help determine which program (Medicaid or Child Health Plus) is for you.

To complete an application by mail:

1. Click here to print a copy of the Access NY Health Care application.
2. Check that your printed copy is complete and looks exactly like the version you see on the screen.
3. Complete all the requested information and sign the application.
4. Review the documentation checklist, decide which documents you need to submit and make copies.
5. Check the income table or use the calculator to see if you need to pay a monthly premium to enroll your children.
6. Select a health plan (here's the list) and call to confirm that it serves your county. To obtain the mailing address of your selected health plan, find it in the list and click on its name.
7. Mail the signed application, a copy of required documents, and a check or money order for the first month's premium to the health plan.