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Please read the instructions below to see which Supplement you should use.If you reside in a county outside of New York City, use Supplement DOH-5178A.Where you apply for Medicaid will depend on your category.Your category might be single, childless couples, pregnant women, parent(s) and caretaker relatives with dependent children, elderly and/or disabled.

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If you are blind or visually impaired many of DOH's forms are available in alternative format DOH-4220 There are two Supplements: DOH-4495A and DOH-5178A.This program pays your Medicare premiums and deductibles.