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(This form has been approved by the New York State Department of Health)

(This form has been approved by the New York State Department of Health) 2025

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The document is an authorization form for the release of health information in accordance with HIPAA and New York State Law. It allows patients to request the disclosure of their medical records, including sensitive information related to alcohol and drug abuse, mental health treatment, and HIV-related information. The form outlines the patient's rights regarding the release of this information, including the ability to revoke consent and the potential risks associated with redisclosure. It also specifies the details required for processing the request.

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What is the income limit for NYS health insurance?

Eligibility New York State residents. Lawfully present in the U.S. 19-64 years old. Not eligible for Medicaid or Child Health Plus. Not eligible for employer and other coverage. Able to meet the Essential Plan annual income requirements listed in the table below.

How do you qualify for NY State of Health?

If you are under 21 years of age, over 65 years of age, certified blind, certified disabled, pregnant, or a parent of a child under 21 years of age, you may be eligible for Medicaid if your income is above these levels and have medical bills.

Is New York State of Health Medicaid?

New York State of Health is your states Marketplace. Visit New Yorks website.

What does the New York State Department of Health do?

The New York State Department of Health (State DOH) protects, improves, and promotes the health, productivity, public safety, and wellbeing of all New Yorkers.

Who qualifies for NY State of Health?

Qualified Health Plans are available through NY State of Health to individuals who are: New York State residents. Citizens, lawfully present applicants, and DACA recipients. Not eligible for Medicaid, the Essential Plan or Child Health Plus.