Provider Enrollment Application Fee

The fee is waived if you are enrolled in Medicare and/or another State's Medicaid Program or Children’s Health Insurance (CHIP) Program or the Fee has been paid (at the current amount or previous amount) to Medicare. The Application Fee Exemption Form (EMEDNY-520101) is required to be submitted along with your application and is subject to verification.

You may request a hardship waiver. Requests for hardship waiver should be sent with your enrollment form and should explain the hardship and justify the waiver, including explaining how your enrollment will ensure beneficiary access to services and supplying relevant business records. New York Medicaid will send your request to the Centers for Medicare & Medicaid Services (CMS) for review pursuant to Section 1866(j)(2)(C)(ii) of the Social Security Act. If the basis of your request is financial, you must include a balance sheet or other financial statement with your justification.