Ny Medicaid Member Notification Pcp Referral Letter
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Clinical Practice Guidelines
UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for preventive health and other health conditions.
View the entire list of guidelines call our Member Services at 1-800-493-4647 to request a printed copy.
How Do I Get Dental Benefits
DentaQuest provides dental benefits to all eligible and enrolled CHP+ child members and to pregnant women. These benefits include preventive and diagnostic services, restorative services, endodontic, periodontic, prosthodontic, oral surgery, and limited orthodontic services. There will be a maximum allowable of $1000.00 per member per calendar year . As with all CHP+ benefits, higher income families may be required to pay a small fee or co-payment when they receive services. CHP+ Prenatal women will not be charged co-payments for dental services. If you have any questions about CHP+ dental benefits call DentaQuest at 1-888-307-6561, TTY 711.
Please visit the DentaQuest Member Access page. After registration, you will be able to search for a dentist, check your benefits, and download your member ID card.
Community Organizations That Can Help You Enroll
- All Counties & All New York City BoroughsCommunity Service Society of New York888-614-5400
- Westchester County Department of Health914-995-6350
- Bronx, Kings, New York, QueensCoalition for Asian American Children and Families 212-809-4675
- Bronx, Kings, New York, QueensNADAP, Inc.
- Bronx, Kings, New York, Queens, Richmond-Hispanic Federation
- Bronx, Kings, New York, Queens, RichmondPublic Health Solutions
- Morris Heights Health Center, Inc.718-483-1260
- Bronx, Kings, New York, Queens, RichmondSingle Stop USA
- Yeled V’Yalda Early Childhood Center, Inc.718-686-2188
- Joseph P. Addabbo Family Health Center718-945-7150 ext. 1102
- Gay Men’s Health Crisis, Inc.-212-367-1029 ext. 1029
- Charles B Wang Community Health Center, Inc. 718-886-7355
- Community Health Center of Richmond, Inc.718-924-2254 ext. 7417
- Jewish Community Center of Staten Island718-981-1400
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Summary Of Child Health Plus
Child Health Plus in NYS offers free or low-cost health insurance to uninsured children from birth through 18 years old. To qualify, families must have incomes below 400% of the federal poverty level, be ineligible for Medicaid, and be residents of NYS. There are no resource requirements and no immigration criteria. There are no deductibles, co-payments or co-insurance, but families with incomes above 160% FPL are required to pay a monthly premium.
All CHP health services in NYS are provided through managed care plans. Application and renewal for CHP is through the NY State of Health Marketplace, where consumers will be able to apply for and renew CHIP coverage, as well as enroll in a health plan.
Because CHP is not a Medicaid program, CHP applicants and members do not have the same notice and fair hearing rights that exist under Medicaid. They do, however, have the right to file grievances, request utilization reviews and obtain an external review of plan decisions.
How Much Does Child Health Plus Cost
The table below shows costs. Monthly premiums depend on income and family size . There is no cost for low income families. Families with higher incomes pay a sliding scale premium as low as $9 and as high as $60 per child, per month. The chart below shows how much per month a family will pay based on their income. The premium is capped at the monthly cost for three children. For example, if a family with four children qualifies for CHP at $9 per month, per child, their monthly premium will only be $27 to cover all four children.
There are no annual deductibles and no co-pays for services in Child Health Plus plans.
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Dental Care That Keeps You Smiling
Healthfirst believes that providing you with good dental care is important to your overall healthcare. Covered services include regular and routine dental services such as preventive dental checkups, cleanings, X-rays, fillings, and other services to check for any changes or abnormalities that may require treatment and/or follow-up care for you. You do not need a referral from your PCP to see a dentist.
What If I Need Immediate Care
You may qualify for a program called Presumptive Eligibility . PE is a way for children and pregnant women to receive care right away without having to wait to see if you are eligible. To apply, you must visit a PE Site and they will do a quick review. If found eligible you will get enrolled for up to 60 days while you wait to see if you qualify. Find a PE Site in your area.
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Child Health Plus Overview
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This article was authored by the Health Law Unit of the Legal Aid Society.
Who Is Eligible For Child Health Plus
Children may qualify for CHP if:
- They are under age 19
- They are New York State residents
- They are not eligible for Medicaid or covered by other health insurance
- They are not eligible for or enrolled in a health plan through a state health benefits program
*All children are eligible regardless of immigration status
Unitedhealthcare Senior Care Options Plan
UnitedHealthcare SCO is a Coordinated Care plan with a Medicare contract and a contract with the Commonwealth of Massachusetts Medicaid program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is a voluntary program that is available to anyone 65 and older who qualifies for MassHealth Standard and Original Medicare. If you have MassHealth Standard, but you do not qualify for Original Medicare, you may still be eligible to enroll in our MassHealth Senior Care Option plan and receive all of your MassHealth benefits through our SCO program.
Ways To Apply For Chip:
- Fill out an application through the Health Insurance Marketplace®. If it looks like anyone in your household qualifies for Medicaid or CHIP, well send your information to your state agency. Theyll contact you about enrollment. When you submit your Marketplace application, youll also find out if you qualify for an individual insurance plan with savings based on your income instead. Create an account or log in to an existing account to get started.
FYI: Apply any time
You can apply for and enroll in Medicaid or CHIP any time of year. Theres no limited enrollment period for either Medicaid or CHIP. If you qualify, your coverage can start immediately.
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Children’s Electronic Health Record Format
The AHRQ/CMS-sponsored work to develop the Children’s Electronic Health Record Format began in 2009 and culminated in the 2013 public release of the format. In 2010, CMS issued quality demonstration grants to 18 states. Two of these states, North Carolina and Pennsylvania, completed demonstration projects to provide CMS with information on the use and impact of standard EHR components for children. These grantee experiences informed the development of the 2015 Priority List. It is hoped the adaptation of EHRs to meet the 2015 Priority List requirements will lead to safer medication use, better tracking and completion of childhood immunizations, improved communication and knowledge about growth and development, better screening and management of children with special health care needs, and a variety of other specific benefits. An explicit goal of this work is to draw vendor, provider, and stakeholder attention to the needs of children, which are often de-prioritized given a limited IT marketplace for pediatric products and a large number of meaningful use EHR certification requirements that consume vendor and practice resources.
Who Administers The Program
Within federal guidelines, each state determines the design of its individual CHP program, including benefit package, payment levels for coverage , who qualifies, and administrative procedures.
On the federal level, the overall responsibility for the administration of the Child Health Plus program lies with the Centers for Medicare & Medicaid Services , an agency of the Department of Health and Human Services.
In New York State, CHP is administered by the NYS Department of Health, Division of Planning, Policy and Resource Development.
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How Long Does Chp+ Coverage Last
- For children, CHP+ coverage begins the date the application is received at the CHP+ office, an Application Assistance Site, or a county office. Coverage lasts at least 12 months.
- For pregnant women, CHP+ Prenatal Care Program coverage begins the date the application is received at the CHP+ office, an Application Assistance Site, or a county office. Coverage will last for at least 365 days after your pregnancy ends.
Out Of Pocket Prescription Reimbursement
If you paid for a prescription while covered by CHP+, but before you enrolled in your health plan, you may ask the pharmacy for a refund.
Contact the pharmacy where you got the prescription. Give them your receipt, State ID number, BIN , and PCN . If you dont know your State ID number or need help, call the pharmacy liaison. Call them at 303-866-3588.
You have 120 days from the date the prescription was filled to ask the pharmacy for a refund. Refunds are not promised.
There may be times when you are charged for the full cost of a prescription medication. This may be if you do not have your ID card when you go to pharmacy that is in our network. Or if you fill a prescription at pharmacy that is not in our network.
If you pay the full cost for a covered prescription medication, please follow these steps:
- Ask for an itemized receipt. This will show that you paid for the medication.
- Please also give us your name and address.
- Mail the itemized receipt and this form for reimbursement to:
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See If Your Children Qualify And Apply For Chip
Each state program has its own rules about who qualifies for CHIP. You can apply right now, any time of year, and find out if you qualify. If you apply for Medicaid coverage to your state agency, youll also find out if your children qualify for CHIP. If they qualify, you won’t have to buy an insurance plan to cover them.
/7 Access To Telemedicine With Teladoc*
Talk to a doctor any timefor a $0 copay. Connect with board-certified doctors through video chat or phone for prescriptions, help diagnosing and treating non-emergency conditions, and more. Access to dermatologists is also available.
*Telemedicine isnt a replacement for your Primary Care Provider . Your PCP should always be your first choice for care .
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Other Childrens Quality Measures Initiatives
CMS also has other initiatives that relate to childrens quality measures, including a Pediatric Quality Measures Program and the Pediatric Electronic Health Record Format. Quality measures are used to evaluate or quantify specific health care processes, outcomes, patient perceptions, or other factors related to health care delivery. The pediatric quality measures are used by state Medicaid and Childrens Health Insurance Programs and other public and private programs, providers, plans, patients, and their families to measure and improve the quality of childrens health care. On October 3, 2016, the Agency for Healthcare Research and Quality and CMS announced awards totaling $13.4 million in funding over four years to six new PQMP grantees focused on implementing new pediatric quality measures developed by the PQMP Centers of Excellence .
See Better With Healthfirst Vision Benefits
Taking care of your eyes doesnt just mean having clear vision. An annual eye exam can help detect a number of health risks, such as diabetes, thyroid disease, high blood pressure, and other conditions. Healthfirst has made it easy for our members to take advantage of this often overlooked preventive service by providing access to comprehensive vision care.
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Which Doctors Can I Visit
CHP+ works with Managed Care Organizations to provide health care to you or your child. Each MCO has their own network of doctors that you or your child can see on CHP+. The county you live in will determine which MCO you or your child enrolls with.
Your CHP+ MCO can help you find a doctor for you or your child.
What If I Need Immediate Care For My Pregnancy
If you are pregnant, you may qualify for a program called Presumptive Eligibility . PE is a way for pregnant women to receive prenatal care right away without having to wait to see if you are eligible. To apply, you must visit a PE Site and they will do a quick review. If found eligible you will get enrolled for up to 60 days while you wait to see if you qualify. Find a PE Site in your area.
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Unitedhealthcare Connected For Mycare Ohio
UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.
Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays, and restrictions may apply. For more information, call UnitedHealthcare Connected Member Services or read the UnitedHealthcare Connected Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
What Benefits Can You Get For Your Children
If your child is enrolled in Children’s Medicaid, you may be required to enroll in a managed care plan, or you may bring your child to any provider who accepts Children’s Medicaid. If your child is enrolled in Child Health Plus, you will be given a list of providers near you. The provider may be a single doctor, group practice of several doctors, or community health center. If it is a group practice, you will be asked to choose a doctor for your child. Either way, you will be getting the personal health care that your child deserves!
- Well-child care
- Diagnosis and treatment of illness and injury
- X-ray and lab tests
- Prescription and non-prescription drugs if ordered
- Inpatient hospital medical or surgical care
- Short-term therapeutic outpatient services
- Inpatient and outpatient treatment for alcoholism and substance abuse, and mental health
- Dental care
- Emergency ambulance transportation to a hospital
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Unitedhealthcare Connected General Benefit Disclaimer
This is not a complete list. The benefit information is a brief summary, not a complete description of benefits. For more information contact the plan or read the Member Handbook. Limitations, copays and restrictions may apply. For more information, call UnitedHealthcare Connected® Member Services or read the UnitedHealthcare Connected® Member Handbook. Benefits, List of Covered Drugs, pharmacy and provider networks and/or copayments may change from time to time throughout the year and on January 1 of each year.
You can get this document for free in other formats, such as large print, braille, or audio. Call Member Services, 8 a.m. – 8 p.m., local time, Monday – Friday . The call is free.
You can call Member Services and ask us to make a note in our system that you would like materials in Spanish, large print, braille, or audio now and in the future.
Language Line is available for all in-network providers.
Puede obtener este documento de forma gratuita en otros formatos, como letra de imprenta grande, braille o audio. Llame al Servicios para los miembros, de 08:00 a. m. a 08:00 p. m., hora local, de lunes a viernes correo de voz disponible las 24 horas del día,/los 7 días de la semana). La llamada es gratuita.
Puede llamar a Servicios para Miembros y pedirnos que registremos en nuestro sistema que le gustaría recibir documentos en español, en letra de imprenta grande, braille o audio, ahora y en el futuro.
Chp+ Managed Care Organizations
CHP+ members are enrolled into a Managed Care Organization . An MCO is a group of doctors, clinics, hospitals, pharmacies, and other providers who work together to help meet your health care needs. Each CHP+ MCO uses its own group of hospitals, pharmacies and doctors for the counties it serves.
There are four CHP+ MCOs in Colorado: Colorado Access, Kaiser Permanente, Rocky Mountain Health Plans, and Denver Health. The county you live in will determine which MCO you or your child enrolls with. If more than one MCO is available in your county, a health plan will be selected for you, but you can change MCOs for up to 90 days after you qualify for CHP+.
If you have any questions, please contact your MCO or visit their website:
- Colorado Access -Customer Service 214-1101 – coaccess.com
- Denver Health Medical Plan -Customer Service 700-8140 – denverhealthmedicalplan.org
- Kaiser Permanente -Customer Service 338-3800 – kaiserpermanente.org
- Rocky Mountain MCO – Customer Service 830-1563 – rmhp.org
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