The NYS Medicaid recertification form LDSS-3174 is the packet your local social services district mails you to renew Public Assistance, SNAP, and Medicaid together when those benefits come up for review, which happens at least once every 12 months.1Legal Information Institute. New York Compilation of Codes, Rules, and Regulations Title 18 Section 360-2.2 – Applying for MA You complete it, attach proof of income and household details, and return it by the deadline printed on your cover letter. Miss the deadline and your benefits end. There is no automatic extension.
One boundary to know up front: the LDSS-3174 renews Medicaid only when you are also recertifying for Public Assistance or SNAP. If you receive Medicaid alone, use Form DOH-4220 or renew online at the NY State of Health portal instead.2New York State Office of Temporary and Disability Assistance. Instructions for Completing the New York State Recertification Form
When Your Packet Arrives and Your Deadline
Your district typically mails the renewal packet about 45 days before your current certification period ends. The cover letter states your recertification deadline. That date is the one that matters. If you moved and didn’t update your address, the packet may not reach you at all, so call your local social services office or check your online account if a renewal feels overdue.
Documents to Gather First
Missing paperwork is one of the top reasons renewals get delayed or denied, so pull everything together before you start writing on the form.
Identity and Residency
You need at least one identity document. A U.S. passport, a New York State driver’s license or enhanced non-driver ID, or a driver’s license from any other state or U.S. territory all work.3New York State Department of Health. Identity Documentation Requirements NYS Medicaid To prove your home address, especially if you’ve moved since your last renewal, include a lease, a landlord letter, a rent receipt, or a utility bill dated within the past six months.4New York State Department of Health. Documents Needed When You Apply for Health Insurance
Income
The proof depends on where the money comes from:
- Wages: four consecutive pay stubs from just before your signature date.
- Self-employment: a signed and dated tax return with all schedules, plus your own records of earnings and expenses.
- Social Security or SSI: your award letter, annual benefit statement, or any recent correspondence from the Social Security Administration.
- Pensions or annuities: a current statement from the provider.5New York State Department of Health. New York State Medicaid Documentation Checklist for Health Insurance
Report every source, no matter how small. Child support, unemployment insurance, rental income, and interest from savings accounts all count. Leaving something off, even by accident, can trigger an overpayment notice or a fraud referral.
Resources
If your caseworker asks for resource documentation, which mainly applies to people 65 and older or those with a disability, you’ll need current statements for every checking and savings account.5New York State Department of Health. New York State Medicaid Documentation Checklist for Health Insurance As of January 2025, the resource limit for non-MAGI Medicaid is $31,175 for one person and $42,312 for two.6New York State Department of Health. New York State Income and Resource Standards for Non-MAGI Population
Household Changes
Have marriage certificates, divorce decrees, or birth certificates ready for any new household members. Moves in and out get reported on the form itself, but the paperwork should be within reach.
Filling Out the Form
The LDSS-3174 runs more than 20 sections, and not all of them apply to every household. The instructions in the packet tell you which sections to skip based on which programs you’re renewing.2New York State Office of Temporary and Disability Assistance. Instructions for Completing the New York State Recertification Form A few sections are worth extra care because they’re where renewals typically go wrong.
Programs, Language, and Your Information (Sections 1–3)
Section 1 is a check-box for the programs you’re recertifying: Public Assistance, SNAP, or Medical Assistance. Check every one that applies. Section 2 asks your primary language and whether you want notices in a language other than English. Section 3 covers your name, marital status, phone number, and residential and mailing addresses. If you’ve moved, list both your current and former address, and note any changes in your circumstances since your last filing.
Household Members (Section 6)
List every person in your household, not just those applying for benefits. Provide each person’s full name, date of birth, sex, relationship to you, Social Security number, and whether they buy and prepare food with you, which matters for SNAP. Indicate which household members are recertifying for which programs. Household size drives the income limit your caseworker applies, so accuracy here is critical.
Citizenship and Immigration (Sections 9 and 10)
For each household member applying, indicate whether they are a U.S. citizen or a non-citizen with satisfactory immigration status. Non-citizens must provide a USCIS number. Section 10 is a short attestation of the information you’ve reported.
Income and Employment (Sections 16 and 18)
Section 16 covers every income source for every household member: wages, Social Security, SSI, child support, foster care payments, and anything else. List the amount and how often it’s received (weekly, biweekly, monthly). Use your pay stubs to enter exact figures rather than rounding. Section 18 asks for employment details: your employer’s name and address, gross pay, hours worked per month, and pay frequency. Health insurance offered through a job gets recorded here too.
Resources, Expenses, and Shelter Costs
Later sections ask about bank account balances, real estate other than your primary home, and vehicle ownership. You’ll also report rent or mortgage, utility expenses, and deductions like child care or medical costs. Those expenses matter because certain deductions can lower your countable income enough to keep you within eligibility limits.7Legal Information Institute. New York Compilation of Codes, Rules, and Regulations Title 18 Section 360-4.1 – Introduction
Signature
By signing, you declare under penalty of perjury that everything in the form is true and complete. A missing signature means the form is treated as incomplete and won’t be processed. If you’re married and your spouse is in the household, both of you sign. Some packets also include an Authorization for Verification of Resources; if that form is in yours, both spouses must sign it separately.
How to Submit
Where you send the completed packet depends on where you live.
New York City
NYC residents whose Medicaid is administered by the Human Resources Administration have three options:
- ACCESS HRA online portal at accesshra.nyc.gov. Click Renew under the Medicaid heading. The process has two steps: complete and submit the renewal form online, then upload your supporting documents through the ACCESS HRA mobile app. Both steps must be finished by the deadline. Submitting the form without the documents does not complete your renewal.8New York City Human Resources Administration. Medicaid Renewal Frequently Asked Questions
- Mail the completed LDSS-3174 and all supporting documents to the HRA address on your cover letter. Certified mail with return receipt gives you proof of the submission date.
- Drop the packet off at your local HRA center and ask for a date-stamped copy of the first page as your receipt.
Outside New York City
Residents in the rest of the state mail or deliver the renewal to their county Department of Social Services, at the address on the packet’s cover letter. Certified mail is worth the small extra cost. Some counties accept faxed documents; call the local office before relying on fax.
What Happens After You Submit
HRA and county offices begin reviewing renewal paperwork roughly 30 days before your current certification period ends.8New York City Human Resources Administration. Medicaid Renewal Frequently Asked Questions A caseworker compares what you reported against state databases (wage records, tax data, and other public-benefit files) to verify income, household size, and resources.7Legal Information Institute. New York Compilation of Codes, Rules, and Regulations Title 18 Section 360-4.1 – Introduction
If something doesn’t match or the caseworker needs more proof, you’ll receive a Request for Information with a response deadline. Missing that deadline is treated the same as not renewing at all.
Once a decision is made, the agency sends a formal Notice of Decision (Form LDSS-4013A) by mail or through your online portal.9New York State Office of Temporary and Disability Assistance. LDSS-4013A – Action Taken on Your Application/Recertification It states whether your coverage continues, changes, or ends; the legal basis for the decision; and your appeal rights. The appeal clock starts from the date on that notice, so read it as soon as it arrives.
If You Missed the Deadline: The 90-Day Reconsideration Window
If your Medicaid was terminated because you didn’t return the form or missed documents, you may not need to start over. Federal rules require states to offer a reconsideration period of at least 90 days for people enrolled under MAGI-based Medicaid, which covers most adults and children. Submit the renewal information within 90 days of the termination date and the state must reconsider your eligibility without a brand-new application.10Centers for Medicare and Medicaid Services. Conducting Medicaid and CHIP Renewals During the Unwinding Period and Beyond: Essential Reminders For non-MAGI populations (people 65 and older, blind, or disabled), New York may offer a 90-day or longer window as well; confirm with your local office.
This is a safety net, not a strategy. Between termination and reinstatement you may have no active coverage and could owe the full cost of any care you receive. Treat the original deadline as the real one.
If You’re Denied: Fair Hearing and Aid Continuing
If your renewal is denied or your benefits are reduced and you believe the decision is wrong, you can request a Fair Hearing through the Office of Temporary and Disability Assistance. Call 1-800-342-3334 or file online at otda.ny.gov/hearings/request/. The deadline is 60 days from the date on your Notice of Decision.
The more urgent piece is “aid continuing,” which keeps your current benefits running while the hearing is pending. To preserve coverage, you generally must request the Fair Hearing within 10 days of the notice date or before the effective date of the termination, whichever is later. Miss that 10-day window and your benefits stop on the effective date even though your hearing is still scheduled.
At the hearing, an administrative law judge reviews whether the agency followed the correct rules. Bring your Notice of Decision, copies of everything you submitted with the renewal, and any additional evidence. If the judge rules in your favor, your coverage is restored retroactively.