Applicants who need to be certified disabled by Medicaid must include two additional forms with the Medicaid application (DOH-4220).

• DSS 486T - Medical Report for Determination of Disability (completed by the physician)
• DSS 1151 - Disability Interview (completed by the individual or a social services professional)

Access NY Supplement must be completed if the applicant is 65 or older, certified blind or disabled or is applying as blind or disabled applicant and Medicaid will certify the individual as blind or disabled, applying for skilled nursing care or community-based long term care services.

English Application

• File Online

• English Application