The New York Application for Reimbursement is a form used by New York State residents to apply for reimbursement of certain Medicaid costs. It is used to request reimbursement for medically necessary services, such as inpatient hospital care, laboratory tests, x-rays, and medical supplies. Additionally, the form can be used to request reimbursement for non-emergency transportation, durable medical equipment, home health care, and other related medical expenses. There are two types of New York Applications for Reimbursement. The first type is for individuals who are enrolled in Medicaid and are requesting reimbursement for services they have received. The second type is for individuals who are not enrolled in Medicaid but are eligible for reimbursement for certain medical expenses. Both forms require the completion of personal information, medical diagnosis, and a description of the services requested. Additionally, a copy of the service provider’s bill must be attached to the application.