Family Health Plus
Frequently Asked Questions
ELIGIBILITY QUESTIONS
Does everyone who lives with me count as part of my household size?
Not necessarily. The rules for who is counted varies depending on each family's or household's circumstances. Generally, anyone applying and anyone living with the applicant who has legal responsibility for the applicants are counted as part of the household and their income is included in the household's income. A spouse is legally responsible for his/her spouse, and parents are legally responsible for their children under the age of 21.
Is child support counted as income for Family Health Plus?
If the child is included in the household size, child support must be counted. Child support is not counted as income if the child is not included in the household size.
If an individual receives Supplemental Security Income (SSI) or Temporary Cash Assistance, is this counted in the household's income?
No, if an individual receives Supplemental Security Income (SSI) or Temporary Cash Assistance, this income would not be counted. Also, this individual will not be included in the household size.
If an individual receives Social Security (i.e., dependent benefits, disability benefits, survivor benefits), would this be counted in the household's income?
Yes, these types of income are all counted and the individual is included in the household size.
Are college student grants, scholarships, work-study or loans considered as income?
Undergraduate educational grants, scholarships, or work-study are not considered as income. The portion of a graduate student's education grant, fellowship or scholarship used for educational purposes only is not considered as income; stipends for living expenses, housing, food, etc., are counted. Neither graduate nor undergraduate student loans are considered as income.
Are college students eligible for Family Health Plus?
Generally, college students will not be eligible for Family Health Plus.
College students - under the age of 21 who are living away from their parent's home only to attend college - must consider their parents' home as their legal and permanent residence, even if they are living in off-campus housing. These minors can apply for health insurance in the county in which their parents live and count their parents' income in determining their eligibility for Family Health Plus.
Minors who establish their own residence in the area near their college (i.e., officially notify the college of the change in their legal residence, change their driver's license and voter registration to this address, and remain near the college whether the college is in session or not) can apply for Family Health Plus in the county where they reside and without counting their parents' income.
We have our own business. Do you count our gross income or our net income when determining eligibility?
Generally, many expenses can be deducted from the self-employed persons' gross income. Because the rules about expenses are complicated, you should seek help from an enrollment facilitator or your local social services district to go over your particular circumstances. Note: If your family has self-employment income, you will need to bring a signed copy of your prior year's Income Tax Return (Form 1040), applicable supporting schedules, and copies of your W-2's to your interview.
What health insurance coverage can I get if I'm pregnant?
A pregnant woman applying for health insurance is not eligible for Family Health Plus but may receive full coverage under Medicaid and/or New York's Prenatal Care Assistance Program (PCAP). Pregnant women should call the Healthy Baby Hotline at 1-800-522-5006 to get answers to their questions regarding income eligibility and to find a PCAP provider near their home or work.
If a woman becomes pregnant after enrolling in Family Health Plus, she will be given the option of continuing her enrollment with Family Health Plus or changing to Medicaid. She should contact her plan and her local social services office to discuss her options and to be sure that her baby will get health care coverage.
Can I "spenddown" to get Family Health Plus coverage (as Medicaid allows)?
Family Health Plus does not have the same rules as Medicaid. You cannot "spenddown" your income by paying medical expenses in order to be eligible for Family Health Plus. If your income is above the Family Health Plus limits, you are not eligible. However, if you are eligible for Medicaid with spenddown, you may also be eligible to enroll in Family Health Plus. Generally, non-disabled, single individuals and couples without children between the ages of 21 and 64 are not eligible to participate in the Medicaid spenddown program. If you are eligible for both programs, you can decide which program is better for you. The local social services district or enrollment facilitator can help you make this decision.
Can non-citizens, including green card holders, get FHPlus?
Yes, citizenship and immigration status requirements for FHPlus are the same as those under the Medicaid Program. Immigrants in many categories, including lawfully admitted permanent residents (green card holders) and persons permanently residing in the United States under color of law (PRUCOL), are eligible to join FHPlus if they meet all other FHPlus requirements. In addition, those otherwise eligible qualified aliens who entered the United States on or after August 22, 1996 may also qualify for FHPlus benefits. Please contact your local county department of social services for further clarification.
What if my income or resources are too high for Family Health Plus?
You may be eligible for the Healthy NY program, another New York State coverage option. Please contact Healthy NY at 1-866-HEALTHYNY or at their website: http://www.ins.state.ny.us/website2/hny/english/hny.htm
HEALTH INSURANCE QUESTIONS
If I think I am eligible for Family Health Plus, should I cancel any other health insurance I might already have?
No. Family Health Plus is a health care program for persons who do not already have health insurance. Individuals should not drop their insurance in order to apply for Family Health Plus. However, if an adult applying for Family Health Plus is also covered by one or more of the following types of limited coverage, they still may be eligible for Family Health Plus (assuming all other eligibility requirements are met).
- Accident-only coverage or disability income insurance
- Coverage issued as a supplement to liability insurance
- Liability insurance, including auto insurance
- Worker's compensation or similar insurance
- Automobile medical payment insurance
- Credit-only insurance
- Coverage for on-site medical clinics
- Dental-only, vision-only, or long-term care insurance
- Specified disease coverage
- Hospital indemnity or other fixed dollar indemnity coverage
- Prescription-only coverage
If you have or can get employer-sponsored health insurance available through your employer you may be eligible for help to pay for premiums, deductibles, coinsurance, and co-payments through the Family Health Premium Assistance Program (federal, state, county, municipal or school district health insurance plans are excluded).
I am paying for my own health insurance. Can I join Family Health Plus?
Adults who have their own non-employer-based insurance, COBRA or Healthy NY may still be eligible for Family Health Plus, assuming all other eligibility requirements are met. Adults cannot enroll in Family Health Plus while their other insurance is still in effect.
Adults who have health insurance through certain employers may be eligible for Family Health Plus Premium Assistance.
Is there a "waiting period" that a person has to be uninsured before he or she can apply for Family Health Plus?
There is currently no waiting period if someone is not covered by health insurance. However, he or she must qualify for Family Health Plus in every other respect.
Can Medicare recipients use Family Health Plus to supplement their health care?
People who have Medicare are not eligible for Family Health Plus because they already have insurance. Also, people who are age 65 or over do not qualify for Family Health Plus. If persons age 65 and over need prescription drug coverage, New York State's Elderly Pharmaceutical Insurance Coverage (EPIC) program may be able to help. EPIC's toll free number is 1-800-332-3742.)
Are people enrolled in Healthy NY eligible for Family Health Plus?
Adults, currently enrolled in the State Insurance Department's Healthy NY program, may apply for Family Health Plus if they meet all other eligibility criteria.
Can I change health plans?
To change FHPlus health plans after you have enrolled, call your local social services district. You have 90 days after you join a plan to decide if that health plan meets your needs. If there is another FHPlus plan available in your county, you can change health plans at any time during this 90-day period. After the 90-day trial period, you must stay with your health plan for the next 9 months, unless you have a special reason to change plans. In all cases, if you want to change plans, you must call your local social services district.
I am enrolled in the AIDS Drug Assistance Program (ADAP or ADAP Plus). Can I also be enrolled in Family Health Plus?
ADAP/ADAP Plus is intended to help HIV-positive people stay healthy by paying for medications, medical care, home care and insurance premium payments. ADAP/ADAP Plus pays for care for individuals who are not enrolled in Medicaid. If an adult is eligible for Family Health Plus, he or she should enroll in Family Health Plus instead of ADAP/ADAP Plus because Family Health Plus covers more medical services. ADAP can help people with the co-payments for medications when they are enrolled in Family Health Plus.
RENEWAL OF FHPlus COVERAGE
I just received a letter stating that I need to renew my eligibility for Family Health Plus. What do I need to do?
You must complete the paperwork that was enclosed with your letter and return it by the date shown on your letter. The package contains a "Documentation Checklist", which shows you what documents can be used to document changes. If the local district office does not receive the information by the date given in your letter, your coverage will end.
I had help when I first applied. Can someone help me with my renewal?
You can call your local social services office or see an enrollment facilitator for help. Be sure to bring your paperwork with you, including the documentation. The package contains a "Documentation Checklist", which shows you what documents can be used to document changes. Please remember that if you do see an enrollment facilitator, it is still your responsibility to return the paperwork to the local district office before the deadline or your coverage will end.
CHILD HEALTH PLUS QUESTIONS
If my children are in Child Health Plus, does that mean I'm eligible for Family Health Plus?
Not necessarily. The maximum income levels for Family Health Plus differ from Child Health Plus. You cannot assume that you will be eligible for Family Health Plus if your child or children are in Child Health Plus.
Will children who are in Child Health Plus have to transfer to Family Health Plus?
No. Children will still be covered under the Child Health Plus program. Child Health Plus is a program for children; Family Health Plus is a program for adults. Parents may enroll in the same plan as their children if that plan is also a Family Health Plus plan.
Will children automatically be enrolled in Family Health Plus when they turn 19 years old?
No. Children (i.e., young adults), who lose eligibility for Child Health Plus because they turn 19, must contact their local social services district or an approved enrollment facilitator to apply.
