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The purpose of this Office of Health Insurance Programs Administrative Directive (OHIP/ADM) is to familiarize local departments of social services (LDSS) and other users with the revised DOH-4220, Access NY Health Care application (Attachment I) and companion forms. This ADM also introduces the Access NY Supplement A, DOH-4495A (Attachment II), which must be completed in addition to the Access NY Health Care application for certain populations.
In addition, this directive provides guidance on policy changes related to specific questions in the revised Access NY Health Care application. Guidance is also provided for LDSS regarding the use of certain district-specific forms.
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