Check If You’re Eligible for Medicaid Meal New York

Free meal and nutrition support programs may be available in your area, check your eligibility to see if your household may qualify for assistance.

Eligibility Screening & Referral Authorization

New York Social Care Network (SCN) Health-Related Social Needs Screening
This questionnaire helps determine whether you may qualify for community services in New York that support health and well-being. These services may include nutrition support, medically tailored meals, housing assistance, transportation services, and other community programs. Your answers may be shared with healthcare providers, Medicaid health plans, and Social Care Networks to determine eligibility for available services. Participation is voluntary. You may choose not to answer any question.

Medicaid Meals Eligibility

Participant Consent

You agree to complete this screening and allow your responses to be shared with healthcare providers, Medicaid plans, and Social Care Networks to determine whether services may be available to you? If eligible, you authorize us to refer you to a participating Medicaid meal provider or other appropriate service provider. Participation in this screening is voluntary, and completing this form does not guarantee eligibility or enrollment in any program.

Are you completing this for yourself or someone else (e.g., family, friend)?

Section 1: Basic Contact & Referral Information

First name

Last name

Date of Birth

Month

Day

Year

Medicaid Client Identification Number (CIN)

Phone

Address

Unit or Apartment No.

City

County

State

Zip Code

Section 2. Food Security

Within the past 12 months, you worried that your food would run out before you got money to buy more.

Within the past 12 months, the food you bought just didn't last and you didn't have money to get more.

Section 3. Housing Security

In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home?

What is your living situation today?

Have any of these major life events been true in the past year?

In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work or from getting things needed for daily living?

Section 4. Public Program Participation Medicaid

Are you (or the person) currently enrolled in Medicaid?

If yes to the previous question, are you (or the person you are completing this form for) currently enrolled in any Medicaid Home and Community-Based Services (HCBS) or long-term care program?

Sectinon 5. Consent & Submission

By providing your phone number and checking this box, you are consenting to receive marketing text messages to that number from Medicaid Meals. Message frequency varies. Message and data rates may apply. Text HELP for help. Text STOP to unsubscribe. SMS opt-in data will not be shared or sold with 3rd parties.

Consent to Share Information for Referral

By submitting this form, you: Confirm that the information you provide is accurate to the best of your knowledge. Authorize Vista Verde Homes to use your responses to evaluate potential program eligibility. Consent to the limited sharing of your contact and qualification information with appropriate government, nonprofit, or community-based service providers for the purpose of facilitating referrals. Understand that participation is voluntary and that you may decline or withdraw from the referral process at any time. Acknowledge that Vista Verde Homes is not a healthcare provider, insurer, or government agency and does not guarantee acceptance into any program.If you do not wish for your information to be shared for referral purposes, you may still contact us for general information about available resources.By continuing, you acknowledge and agree to this eligibility screening and referral authorization.

Check If You’re Eligible for Medicaid Meal New York

Free meal and nutrition support programs may be available in your area, check your eligibility to see if your household may qualify for assistance.

Eligibility Screening & Referral Authorization

Medicaid Meals Eligibility

Medicaid Meals by Vista Verde Homes