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Your New York Access NY Health Care Form (DOH-4220), Explained
Also called: Access NY Application, Access NY Health Care
Last reviewed 2026-07-08
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What this notice usually means
Form DOH-4220 is New York's paper Medicaid form. Some groups, such as older or disabled applicants, use it to apply. New York reuses the same form each year for renewal.
What to do now
- 1
Find the deadline on your notice
New York Medicaid prints the exact deadline on your own packet. Look for that date first, since it controls what happens next, not a general date on this page.
- 2
Gather the information New York Medicaid asks for
Your packet lists the household details already on file. Check each line and correct anything that has changed, then add any papers requested.
- 3
Send the form back through a listed channel
You can usually return it online, by mail, by fax, or in person. Use the address or number printed on your own packet.
- 4
Call New York Medicaid if anything is unclear
Call the phone number printed on your notice if a question on the form does not make sense.
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“ACCESS NY HEALTH CARE Medicaid ... I agree to have the information on this application and on the annual renewal shared only among Medicaid, the health plans indicated in Section I, the local department of social services, and the organization providing the application assistance.”
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In New York
- Phone
- (800) 541-2831
- Online portal
- NY State of Health
Ways to send it, from the published rules:
- Online
https://nystateofhealth.ny.gov
NY State of Health enrollees: log into your account and click the 'Update Application' button when your renewal is due. Requested documents can also be uploaded in the account or via the NY State of Health mobile upload app.
- Phone
NY State of Health Customer Service Center (TTY: 1-800-662-1220). Renew over the phone Mon-Fri 8:00 AM-8:00 PM, Sat 9:00 AM-1:00 PM.
- Phone
NYS Medicaid Helpline for renewal questions (Mon-Fri 8:00 AM-8:00 PM, Sat 9:00 AM-1:00 PM), especially for LDSS/NYC HRA enrollees.
- Mail
LDSS/NYC HRA enrollees: return the completed, signed renewal packet with all requested documents by USPS mail by the date on the renewal form (do not send original documents). Use the address on your renewal packet.
- Fax
LDSS enrollees may return the renewal form by fax (number on your renewal packet). Documents can also be uploaded via the NYDocSubmit app in participating counties.
- In person
Drop off the renewal packet in person at your Local Department of Social Services, or at HRA for New York City cases.
- Online
NYC HRA enrollees can submit the renewal packet online through Access HRA.
Sources
- New York State Department of Health (health.ny.gov)Retrieved 2026-07-07
Last reviewed 2026-07-08
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