Want us to call you? Schedule a callback from our Intake TeamOnly New York State Medicaid recipients are eligible.Enter your info, and we’ll call you back when it’s good for you Schedule a Callback Now You may be eligible! Fill out this form to find out. We'll check to see if you're eligible to apply — then Medicaid and your health plan will determine your final eligibility. First Name Last Name Medicaid ID Number Your Phone Number Your Email Are you the Patient? Yes No Does the patient have Medicaid? Yes No I don't know Am I Eligible? *Marked fields are required fields.