All individuals who are Medicaid eligible are required to enroll in a Medicaid Managed Care Plan unless they have been identified as either exempt or excluded.
What is Medicaid Managed Care?
Medicaid Managed Care provides Medicaid-eligible individuals access to health care through Medicaid Managed Care Plans. These plans provide the majority of Medicaid services such as primary, specialty, ancillary and inpatient services. Medicaid services such as pharmacy and dental will continue to be provided through the traditional Medicaid system.
Who must join?
All Medicaid-eligible individuals, unless they are determined to be exempt or excluded.
Who is exempt or excluded from Managed Care?
Exempt [not required to enroll, but may enroll voluntarily]:
- Individuals currently being treated for a chronic medical condition.
- Native Americans.
- Individuals who cannot be served due to language barrier.
- Providers not geographically accessible.
Excluded [not eligible to enroll, even voluntarily]:
- Individuals who are dually eligible [Medicare/Medicaid].
- Medicaid Spenddown recipients.
- Foster children in the placement of a voluntary agency.
- Individuals in the Recipient Restriction Program.
- Individuals covered under other insurance (Third Party Health Insurance).
- Permanent residents of residential health care facilities.
- Infants weighing less than 12 grams, or other
Above examples represent the most common exempted/excluded categories of individuals.
What does Medicaid Managed Care cost?
There is no cost to enroll.
What services are covered?
- Physician services.
- Inpatient and outpatient health care.
- Lab tests and x-rays.
- Vision, speech and hearing services.
- Short-term rehabilitation.
- Durable medical equipment.
- Emergency room and emergency ambulance services.
- Mental health/alcohol and substance abuse treatment [as medically necessary].
- Family planning.
- Radiation therapy, chemotherapy, hemodialysis.
How is care provided?
Medicaid Managed Care is provided through various Medicaid Managed Care Plans.
How does a person enroll in Medicaid Managed Care?
New York Medicaid Choice is the designated State Enrollment Broker. New York Medicaid Choice assists consumers in selecting and enrolling in Medicaid Health care plans. New York Medicaid Choice can be contacted by doing the following:
- If enrolling into a Health Plan: Call 1-800-505-5678; TTY: 1-888-329-1541).
- Visit the online website http://www.nymedicaidchoice.com/. Those enrolling will need to provide their case number, which is listed on the enrollment letter from New York Medicaid Choice or on any letter received as part of an individual's Medicaid case.
Participating Managed Care Plans:
Fidelis Care of New York
40 John Glenn Drive
Amherst, New York 14228
511 Farber Lakes Drive
Buffalo, New York 14221
Univera Community Health/Plus Med
205 Park Club Lane
Buffalo, New York 14221
WellCare Health Plans
360 Delaware Ave.
1st Floor South
Buffalo, New York 14202