New York Medicaid Choice fax number
The New York Medicaid Choice fax number for the Authorized Representative Designation Form is (917) 228-8601. It is not for enrolling in a health plan or changing plans. New York Medicaid Choice takes enrollment online, by phone or by mail, and plan changes by phone.
Authorized Representative Designation Form
(917) 228-8601
Also written 917-228-8601
2 weeks ago · 10-06-2026 ProntoFax user, 1 send in 90 days Fax this number
This line also takes a copy of a legal document that authorizes someone to act for you under New York State law, such as a court order establishing guardianship or a power of attorney, in place of the form.
ProntoFax is an independent fax service. We are not affiliated with, endorsed by, or connected to New York Medicaid Choice, Maximus, or the New York State Department of Health.
Where to mail the form
New York Medicaid Choice also takes the form by mail. Send it one way only, by fax or by mail.
Authorized Representative Designation Form
New York Medicaid Choice
PO Box 5009
New York, NY 10274
Fax: (917) 228-8601
2 weeks ago · 10-06-2026
How we verify fax numbers
Every number on this page was published by the agency itself. The two columns beside it say when that number was last confirmed, and what confirmed it.
The Verified by column says which of these it was:
Official website the agency publishes this number. The date is the day we read it from their page or their published file.
ProntoFax user a fax sent through ProntoFax reached this number and the receiving machine confirmed it. The date is the most recent delivery.
ProntoFax automation we called the number and heard a fax tone answer. Nothing is sent and the call ends as soon as the line answers.
Needs verification recent attempts to this number did not go through. It stays listed because the agency still publishes it, but check it against your own letter before you send.
The date is colored by how long ago it was:
Within 90 days 91 to 270 days Over 270 days
We never add a number because someone faxed it. A number appears here only if the agency published it. A delivered fax can confirm a number, but it can never create one.
What goes to this number
New York Medicaid Choice names two things you can send to this number:
- The Authorized Representative Designation Form, filled out and signed
- In place of that form, a copy of a legal document that authorizes someone to act for you under New York State law, such as a court order establishing guardianship or a power of attorney
Before you send
New York Medicaid Choice publishes no cover sheet for this fax. A short one still helps match the form to your case, and if you use one, include:
- Your name as it appears on your Medicaid case
- Your Medicaid ID number, if you have it
- The name of the person you are authorizing
- A phone number where you can be reached
- The number of pages, including the cover sheet
Send the whole form in one fax, signed wherever it asks for a signature.
Keep your delivery confirmation. It is your record of when the form reached New York Medicaid Choice.
Official New York Medicaid Choice pages
Send it from your phone
Photograph each page with your phone camera, or upload a PDF.
Put a cover sheet first, with your name and a phone number.
Check every page in the preview before anything goes out.
Enter the fax number above. We check that the line can receive.
Pay $2.99 and watch it send. If it is not delivered, you are not charged.
Pay only when delivery is confirmed
Why ProntoFax
- Flat $2.99 per delivered fax, no subscription
- No account or sign-up required
- Up to 25 pages in one fax
- We validate the fax line before you pay
- No charge if your fax does not go through
- Email receipt with delivery time, page count, and a link to view the document you sent
Questions about faxing New York Medicaid Choice
What is the New York Medicaid Choice fax number for?
Returning the Authorized Representative Designation Form, which names someone to act for you with New York Medicaid Choice. It is the number at the top of this page. The other New York Medicaid Choice pages we checked list no fax number.
Can I fax a power of attorney instead of the form?
Yes. New York Medicaid Choice says it can accept a copy of a legal document that authorizes someone to act for you under New York State law, such as a court order establishing guardianship or a power of attorney, in place of the form. Send it the same way.
Can I enroll in a plan or change plans by fax?
Not at this number. New York Medicaid Choice says you can enroll online, by phone or by mail, and that you change plans by calling it. Its enrollment and plan-change pages are linked above.
How much does it cost?
$2.99 for one fax of up to 25 pages. No subscription and no account. Your card is held and only charged once delivery is confirmed.
Send your fax in about two minutes
No account, no subscription. $2.99 when it is delivered.