New York Health Access - Medicaid Managed Care

Medicaid Managed Care

	Restricted Recipients MEDICAID MANAGED CARE FACT SHEET Restricted Recipients- the way you receive your Medicaid benefits is changing! On August 1, 2011, Medicaid recipients who are restricted to certain providers will have to enroll in a Medicaid health plan. Before August 1, 2011, restricted...


	New York Dramatically Expands Mandatory Managed Care for Medicaid Beneficiaries Many people who used to be exempt from mandatory enrollment in Medicaid managed care have been receiving notices in summer and fall 2012 telling them that their exemption has ended, and that they now have 30 days to enroll in a managed care plan. This type of managed care is sometimes called...


	Medicaid Transportation in NYS States are required under federal regulations (42 C.F.R. §431.53) to assure necessary transportation to Medicaid beneficiaries to and from medical services. When travelling to medical appointments, a Medicaid beneficiary is expected to use the same mode of transportation as the beneficiary...


	Dental and Orthodontic Services to be Included in the Medicaid Managed Care Benefit Package Know Your Rights: What You Need to Know About the Expansion of Medicaid Dental Coverage in NYS (2024) Dental Services to be Included in the Medicaid Managed Care Benefit Package Effective July 2, 2012, dental services for Medicaid beneficiaries must be obtained through the member's...


	Grievance and Appeal Contacts for Managed Long Term Care Plans SINCE MARCH 1, 2018, members of Medicaid Managed Care and Managed Long Term Care plans will be required to request an INTERNAL APPEAL within their plan, and wait until the plan decides that appeal before they may request a FAIR HEARING when they receive an Initial Adverse Determination denying or...


	Appeals & Grievances in Managed Long Term Care - "Exhaustion" of Plan Appeal Required since 2018 In 2016, CMS adopted changes in federal Medicaid managed care regulations requiring "exhaustion" of Plan Appeals prior to requesting a Fair Hearing. These changes became effective in NYS in MAY 2018. The federal changes are in 42 CFR 438 SubPart F. NYLAG 2018 Trainings on Changes: View the...


	New York Medicaid Expansion Know Your Rights: What You Need to Know About NYS Medicaid Expansion in 2023 This year’s Health Budget makes significant changes to New York’s Medicaid program – expanding eligibility to 133% of the federal poverty law (FPL) and changing budgeting rules and enrollment processes for...


	Statistics on Medicare and Medicaid Managed Care -- Enrollment Numbers and other Data -- New York State Numbers tell a big part of the story of how managed care plans are doing in providing care. With mandatory enrollment in Medicaid managed care now required in every county in New York State for most people who do not have Medicare, and mandatory enrollment in Managed Long Term Care of those adults...


	"Ensure" and Enteral Nutritional Supplements - When does Medicaid Pay for it? 2013 Changes for Adults Children under 21 are entitled to obtain "Ensure" or other nutritional supplements when medically necessary. However, the State has enacted laws in the last few years that restrict eligibility for nutritional supplements for adults age 21+. In 2011, the state budget law limited these "enteral...


	Previous Medicaid Dental Benefit in NYS (Rules Effective for Services Requested Through 1/30/24) New York’s Medicaid program includes limited dental benefits. The coverage was expanded beginning on January 31, 2024 as the result of the settlement of the Ciaramella v. McDonald case (originally Ciaramella v. Zucker). This article explains Medicaid dental rules in effect until January 31,...


	Behavioral Health Carve-In Significant changes are taking place in 2015 and 2016 in the delivery of behavioral health care in Medicaid managed care. This article will continue to be updated as information becomes available from the Department of Health. Behavioral Health Carve Outs For many years, people who are...


	Medicaid Contacts in New York City (NYC Human Resources Administration - MICSA) August 5, 2024 - address for main NYC Medicaid Office - called the Brooklyn South Medicaid office - has been changed to 495 Clermont Avenue, Brooklyn, NY 11238. This is around the corner from the previous address on Atlantic Avenue since 2013 see 2024-08-02 Change of address for Brooklyn_South...


	Providers Must be Enrolled in NYS Medicaid Program to ORDER/PRESCRIBE/REFER/ATTEND Medicaid Services - Including Providers in Managed Care Plans - also Tool to Find Medicaid Providers What types of providers are affected? Effective January 1, 2014, medical providers must be enrolled with the NY State Medicaid program in order for Medicaid to pay for services that they prescribed, ordered or referred. The rule applies to ordering, prescribing, referring and attending...


	What You Need to Know About the Expansion of Medicaid Dental Coverage in NYS By the Legal Aid Society Thanks to a settlement secured by Legal Aid in Ciaramella v. McDonald many more New Yorkers will be eligible for additional dental procedures under Medicaid by early 2024. What dental services does the settlement impact? Root canals, crowns, dental implants, and...

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