Grandparent Raising Grandchild Medicaid New York — How to Get Health Coverage

The Tax-Dependent Question Changes Everything

When you apply for health coverage for a grandchild through NY State of Health, the system uses Modified Adjusted Gross Income (MAGI) rules to determine eligibility. One question drives the entire calculation: do you claim the child as a tax dependent?

If you do not claim the child as a dependent: The child is evaluated as a household of one. Only the child's own income — survivor benefits, SSI, trust income — counts. Most children in kinship care have little or no personal income, which means they qualify for full Medicaid coverage with no premiums and no copays.

If you do claim the child as a dependent: The child becomes part of your tax household. Your total household income is evaluated against MAGI thresholds. This can still result in Medicaid eligibility if your income is low enough, but it opens the door to the child falling into a higher bracket and needing Child Health Plus instead.

For most kinship caregivers, not claiming the child as a tax dependent results in better health coverage for the child. But the tax question also affects your eligibility for the Empire State Child Credit and federal tax benefits — so it is worth weighing both sides.

Medicaid for Children

New York Medicaid for children covers comprehensive services: primary care, specialist visits, hospitalizations, prescription drugs, pediatric dental, vision, behavioral health, and more. There are no premiums and no copays for children on Medicaid.

Children automatically qualify for Medicaid if they receive child-only cash assistance (TANF). If the child is approved for a child-only grant, Medicaid enrollment should follow without a separate application.

Child Health Plus (CHP)

If the child's household income exceeds Medicaid thresholds, Child Health Plus fills the gap. CHP covers children under 19 living in New York regardless of immigration status.

Monthly premiums depend on household income as a percentage of the Federal Poverty Level:

These premium levels apply to applications processed on or after February 17, 2026.

CHP covers the same essential services as Medicaid: doctor visits, hospital care, prescriptions, dental, vision, and mental health services. There are no copayments for services.

How to Apply

Through NY State of Health: Go to nystateofhealth.ny.gov and create an account. The marketplace processes MAGI eligibility determinations for Medicaid and CHP.

Through the LDSS-2921: If you file the combined application for cash assistance, health coverage screening is included. You may receive a separate determination notice for Medicaid.

Through the child-only grant: If the child is approved for TANF cash assistance, Medicaid is automatic — categorical eligibility, no separate income test.

After Enrollment

You will need to select a managed care plan operating in your county. If you do not choose within 30 days of the eligibility determination, the state auto-assigns one.

Renewals happen every 12 months. Update your address immediately in NY State of Health or myBenefits if you move — a missed renewal notice can result in a gap in coverage.

If coverage is denied or reduced, you can request a Fair Hearing through OTDA for fee-for-service Medicaid decisions, or file a plan appeal for managed care decisions. The complete New York kinship benefits guide covers the appeal timelines and Aid Continuing rules for health coverage alongside every other benefit program.

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