💰 Benefits & Hearings

Words used in SNAP, Medicaid, and fair hearing notices.

• ABLE Account (529A, Achieving a Better Life Experience Account)A tax-advantaged savings account for a person whose disability began before a federal age cutoff (raised to 46 starting in 2026). Annual contributions are cappe…
• Adequate Notice (Notice of Intent, Action Taken Notice)A written notice from the benefits agency before it changes, reduces, or stops benefits. The law requires it to say exactly what is being changed, why, what rul…
• Aid Continuing (Aid to Continue, Aid Pending)A rule that keeps a person's benefits going at the same level while they wait for a fair hearing decision. It applies to SNAP, Temporary Assistance, Medicaid, a…
• Balance Billing (Surprise Bill, Out-of-Network Bill)Balance billing happens when an out-of-network doctor or provider charges a patient for the difference between their full price and what insurance paid. For exa…
• CDPAP (Consumer Directed Personal Assistance Program)A New York Medicaid program that lets people who need home care hire, train, and supervise their own caregiver. The caregiver can be a family member, friend, or…
• Charity Care (Financial Assistance Program, Hospital Financial Aid)A hospital program that reduces or forgives medical bills for patients who cannot afford to pay. Every nonprofit hospital in New York (which includes most hospi…
• Co-Pay (Copay, Copayment, Co-Payment)A fixed dollar amount the patient pays each time they see a doctor, fill a prescription, or use certain health services. Insurance pays the rest. For Medicaid i…
• COBRA (COBRA Continuation Coverage, Consolidated Omnibus Budget Reconciliation Act)A federal law that lets eligible workers and their dependents keep employer-sponsored health insurance for a limited period after a qualifying event. Common qua…
• DeductibleThe amount of money a patient pays for health care before insurance kicks in. With a deductible of, say, several hundred dollars, the patient pays the first str…
• EBT Card (Electronic Benefits Transfer, SNAP Card, Benefits Card)A card the state issues to access SNAP (food) benefits and sometimes cash assistance. It looks and works like a regular debit card. The recipient swipes it at t…
• Eligibility Determination (Eligibility Decision, Determination)The official decision by an agency about whether an applicant qualifies for a program. After the application is filed, the agency reviews the applicant's income…
• Emergency Room Rights (ER Rights, EMTALA)Under a federal law called EMTALA (Emergency Medical Treatment and Labor Act), every hospital with an emergency department must screen and stabilize anyone who …
• ERISA (Employee Retirement Income Security Act)A federal law that governs most employer-sponsored retirement plans (pensions, 401(k)s) and many employer-sponsored health plans. ERISA sets minimum standards f…
• Explanation of Benefits (EOB) (EOB)A statement sent by a health insurer to the member after a claim is processed. The EOB shows the date and place of service, the provider's billed amount, the am…
• Fair Hearing (Administrative Hearing, OTDA Hearing)A free hearing at the state level where a person can challenge a decision made by their county's Department of Social Services. The applicant can ask for one if…
• Federal Poverty Level (FPL, Poverty Level, Poverty Line, % FPL)A dollar amount set by the federal government each year that represents the minimum income a household needs. Programs use it to set eligibility. For example, M…
• Formulary (Health Insurance) (Drug List, Preferred Drug List)The list of prescription drugs that a specific health insurance plan covers. Most plans organize the formulary into tiers. Generic drugs are usually the lowest …
• HEAP (Home Energy Assistance Program, Heating Help)A program that helps low-income households pay for heat. In New York, HEAP has two parts. Regular HEAP gives a one-time payment toward the household's heating b…
• Hospice (Hospice Care, End-of-Life Care)Hospice is a type of care for people with a terminal illness who are expected to live six months or less. Instead of trying to cure the illness, hospice focuses…
• In-Network (Health Insurance) (Network Provider, Participating Provider)A health care provider that has a contract with a specific health insurance plan to provide services at agreed prices. In-network providers usually charge the p…
• Managed Care (Managed Care Plan, MCO, Health Plan)A type of health insurance where a private company manages a member's care. In New York, most Medicaid recipients must choose a managed care plan (like Fidelis,…
• MedicaidFree or very low-cost health insurance for low-income New Yorkers. It pays for doctor visits, hospital stays, prescriptions, dental, vision, mental health, and …
• MedicareA federal health insurance program that covers people age 65 and older, people who have received SSDI for at least 24 months, and people with end-stage renal di…
• MOLST (Medical Orders for Life-Sustaining Treatment)A bright pink form under New York Public Health Law § 2977 that documents a seriously ill patient's specific end-of-life treatment decisions as actual medical o…
• Prior Authorization (Prior Auth, Pre-Authorization, PA)A requirement by an insurance plan that a doctor get permission before providing certain services. The doctor submits paperwork explaining why the service is ne…
• Recertification (Recert, Benefits Renewal, Redetermination)A periodic check by the benefits agency to make sure the recipient still qualifies for the program. SNAP, Medicaid, Temporary Assistance, childcare subsidies, a…
• Recoupment (Overpayment Recovery)When a benefits agency reduces a recipient's current benefits to pay back benefits paid earlier that the recipient was not entitled to. For Temporary Assistance…
• Representative Payee (Rep Payee, Payee)A person or organization that Social Security appoints to receive and manage benefits for someone who cannot manage their own finances — usually because of a di…
• Sliding Scale (Sliding Fee, Income-Based Fee)A pricing system where the cost of a service depends on the patient's income. Lower earnings mean a lower rate. Some places charge nothing at all for people bel…
• SNAP (Food Stamps, Supplemental Nutrition Assistance Program, EBT)A federal program, run by the state, that helps low-income people buy food. Money goes onto an EBT card each month. In New York, applications can be filed onlin…
• Spend-Down (Medicaid Spend-Down, Excess Income)A way to qualify for Medicaid when an applicant's income is above the normal limit. The amount above the limit is the 'excess income.' Each month, the applicant…
• SSI vs SSDI (SSI, SSDI, Supplemental Security Income, Social Security Disability Insurance, Disability Benefits)Two different federal programs for people with disabilities. SSI (Supplemental Security Income) is for people with little or no work history who have a disabili…
• TANF (Temporary Assistance for Needy Families, Family Assistance)A federal block grant that funds state cash assistance programs for low-income families with children. Each state designs its own program within federal rules. …
• Temporary Assistance (TA, Public Assistance, Welfare, Family Assistance, Safety Net)Cash help from the state for people who do not have enough to cover basic needs like rent, utilities, and food. There are two kinds. Family Assistance is for ho…
• Verification (Proof, Documentation, Supporting Documents)The documents an agency requires to prove an applicant qualifies for a program. Common verification items: photo ID, Social Security card, proof of income (pay …
• Weatherization (Home Weatherization, Energy Retrofit)Weatherization is a federal and state program that provides free home energy upgrades to low-income homeowners and renters. The upgrades typically include addin…
• WIC (Women, Infants, and Children)A federal nutrition program for pregnant women, new mothers (up to 6 months postpartum, or 1 year if breastfeeding), infants, and children under 5. WIC provides…