Medicaid: More For You In 2022
The New York State Medicaid Managed Care Plan is offered through UnitedHealthcare Community Plan. Its for New York State residents who meet the income or disability requirements.
Covered doctor visits:
- Primary care provider visits
- Specialists visits
- Mental health and substance use treatment
- Care management
Can I Print A Replacement Medicaid Card
In the state of New York, you cannot print a replacement card. In other states you can, so people may be confused to learn this if they have recently moved. It is not legal to print replacement cards from your home.
This is partly because Medicaid fraud is common in New York and the state government wants to ensure that cards are not being used for more than one person. To keep your card and yourself safe, make sure you are not giving your ID number out.
You can also follow these tips to avoid fraud:
Never post your Medicaid number of information online
Treat the medical card the same as your social security card and keep it in a safe place. Do not share the number with anyone.
Never give the number to people who come to your home saying they need it for medical testing or exams.
The only people that should have your Medicaid number are yourself and your doctors. The only time you should show people your Medicaid card is when you are visiting a clinic or hospital.
Renewing Through Government Agencies
You need to renew your Medicaid coverage every year.
The NY State of Health Marketplace will send you a letter or an email with your renewal date for you to call and renew without losing any coverage. Pay close attention to the date on your letter you must renew by that date in order to keep your coverage. You can typically renew 30 days from the date you receive your letter. If you dont understand your letter or if you need help, call us at 1-888-432-8026.
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Helping People Is At The Heart Of All We Do
All New Yorkers deserve affordable health care, including you. We offer many plans to help New Yorkers get healthy and stay healthy. Our plans cover children, pregnant women, adults and people with disabilities.
Choose a plan that gives you more. UnitedHealthcare has a large provider network in New York. That gives you more options to choose the right doctors and specialists for you and your family. We also offer more benefits and extras, which can make a real difference in your life.
What Services Does Ppgny Provide If I Am In A Medicaid Health Plan
If you have Medicaid or Medicaid managed care, you can come to Planned Parenthood for:
- Birth control pills, condoms, foams, diaphragms, IUDs, and Depo-Provera
- Pelvic and breast exams, including Pap tests*
- Pregnancy testing and counseling
- Colposcopy, cryotherapy, and loop electrosurgical excision procedures *
- STD testing and treatment*
*when part of a family planning visit
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How Do I Get A New Medicaid Card In Ny
If you have lost your card or think it may have been stolen, you will need to report it to the Department of Health and Human Services. Much like a credit card, Medicaid cards can have fraudulent activity that needs to be reported and watched closely.
If your children have Medicaid cards, you might want to consider keeping them for them to minimize the risk of them being lost or stolen.
Once you have reported the card stolen, you can call the New York State Department of Healths Medicaid Help Hotline at 1-800-541-2831. There is also a number on the back of your Medicaid card that you can call if you are replacing a damaged card still in your possession.
There are several ways you can get a new Medicaid card in the event it was lost or stolen:
Online at New York Citys official website. You will need your birth date and the CIN# or the Case#.
By email
By mailing in a replacement form
By faxing in a replacement form
By applying in person at the Medicaid office
By calling 311 and talking to a representative
The representative on the phone will ask you some identifying questions such as your social security number, birth date, and address. They will also ask for your Medicaid ID number which may be hard to locate if you have lost the card. Consider keeping your ID number written down somewhere or have it saved on your computer.
To fill out the Medicaid form for a replacement card make sure you fill it out correctly with:
Your birthdate
Your Medicaid ID number
I Am Enrolled In A Medicaid Health Plan Can I Come To Ppgny
Yes. New York State law says you can go to any Medicaid provider in or out of the health plan for the GYN, family planning, and abortion services you need. Please see the list of those services below. That means you can always come to PPGNY it doesn’t matter if PPGNY is in your Medicaid health plan or not. You don’t need a referral from your regular doctor.If PPGNY is not in your health plan or if your health plan does not cover the services you need, you can still use your Medicaid card. Bring your health plan card and your Medicaid card to the visit. You will not be turned away.
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What If I Dont Want My Medicaid Doctors And Providers To See My Health Information Through This Website
You can opt out of sharing. Opt-out means that you choose not to share your health information. To opt out, go to and then:
You can also opt out by calling 800-252-8263. If you opt out, we wont share your health information with Medicaid doctors or other providers.
I Don’t Have Any Health Insurance Will Ppgny Still See Me
Yes. If you do not have health insurance, you can still come to PPGNY. We will help you enroll in public or private insurance, or help you access financial support for the services we offer. If you are not able to obtain health insurance, our centers may still be able to offer you a lower fee, depending on your income and the services that you need. No one will be denied access to services due to an inability to pay. We offer a sliding fee scale that is based on your family size and income.
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Welcome To Nyrx The Medicaid Pharmacy Program
The New York State Medicaid Pharmacy program, NYRx, covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid members. Prescription drugs require a prescription order with appropriate required information. Non-prescription drugs, often referred to as Over-the-Counter or OTC drugs, require a fiscal order . Certain drugs/drug categories require the prescribers to obtain prior authorization. Information on this benefit can be found in the New York State Medicaid State Plan Amendment.
Beginning April 1, 2023, Medicaid members enrolled in mainstream Managed Care plans, Health and Recovery Plans , and HIV-Special Needs Plans will have their pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program. The transition will not apply to members enrolled in Managed Long-Term Care plans , the Essential Plan, or Child Health Plus.
Pharmacy program and billing policy and other pharmacy related information can be found in the NYS MMIS Pharmacy Provider Manual and the Department’s Medicaid Update. You may also contact us at or 486-3209 for Medicaid pharmacy policy related questions.
Essential Plans In 2022
You may qualify for low- or no-cost health care. The Essential Plan offered through NY State of Health by UnitedHealthcare® Community Plan is for lower-income individuals in New York, ages 1964, who dont qualify for Medicaid or Child Health Plus.
What does it include?
- Routine eye exams, including glasses
- Hearing exams and hearing aids
- Prescription drugs
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When To Contact Your State Medicaid Agency
In order to assist you in getting a timely response, please contact your State Medicaid Agency for any questions on the following:
If you need assistance in any of the areas noted, you will need to contact the agency for Medicaid/CHIP in your state of residence or the state you have questions about in order to receive assistance. Please contact your state for all state-related Medicaid questions.
What Are The Benefits Of Having A Medicaid Card
The benefits of having Medicaid are numerous. It allows you to get affordable health care and access to services you otherwise might have a hard time paying for.
You can use your Medicaid card for:
Regular exams
Hospital services
Family planning services
Transportation services to and from medical appointments
Emergency room visits and emergency transportation costs
Prescriptions
Home health care and personal care
Counseling, psychiatric care, and therapy
Prenatal and postnatal care for pregnant women
This list is not exhaustive. There are several other places you can use your Medicaid card and more services available to you.
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Applying For A Replacement Medicaid Card In
If you go to Health and Human Services in-person to replace a stolen or lost Medicaid card, find a member of the staff and ask them for assistance with your lost, damaged, or stolen Medicaid card. Be prepared to provide a photo ID to verify that you are who you say you are. An appropriate form of identification includes the following:
How To Apply For Ny Medicaid
You may apply for Medicaid in the following ways:
- Enrollment Assistors offer free personalized help.
- To speak with the Marketplace Customer Service Center call 355-5777
- Through a Managed Care Organization
- Call the Medicaid Helpline 541-2831
- Through your Local Department of Social Services Office
Where you apply for Medicaid will depend on your category of eligibility. Certain applicants may apply through NY State of Health while others may need to apply through their Local Department of Social Service . No matter where you start, representatives will help make sure you are able to apply in the correct location. For more information on determining your category of eligibility and where you should apply read on.
NY State of Health determines eligibility using Modified Adjusted Gross Income Rules. In general, income is counted with the same rules as the Internal Revenue Service with minor variations. Individuals who are part of the MAGI eligibility groups listed below should apply with NY State of Health.
- Adults 19-64 years of age who are not eligible for Medicare,
- Children 1 – 18 years of age
- Pregnant Individuals,
- Parents and Caretaker Relatives of any age, who may have Medicare.
Individuals who are part of the non-MAGI eligibility groups listed below should apply with their Local Department of Social Services .
Other factors that may affect your eligibility include:
- State Residency
- Family or Household size
Medicaid Application for Non-MAGI Eligibility Group
Supplement A
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Apply Through The Dutchess County Department Of Community & Family Services If You Are:
- Age 65 and older
- Enrolled in Medicaid Buy-In for Working People with Disabilities enrollees
- Former foster care youth
- Resident of adult homes and nursing homes
- Resident of treatment center/community residences operated by the Office of Mental Health
- Applying for AIDS Health Insurance Program or Medicaid Cancer Treatment Program
- Applying for Medicare Savings Program
- Your eligibility is based on being blind or disabled or you request coverage for community based long term care services including those individuals with an immediate need for Personal Care Services or Consumer Directed Personal Assistance Services
Why You Need Your Id Cards
You need to show your medical insurance cards:
- At every doctor visit.
- If you visit a behavioral health provider.
- If you need non-emergency transportation.
To get service, you may need to show your:
- AmeriHealth Caritas Delaware ID card.
- Medicaid ID card.
- Other health insurance cards you may have.
If you need help or if you have questions about your cards, call AmeriHealth Caritas Delaware Member Services, 24 hours a day, 7 days a week, at:
- Diamond State Health Plan: 1-844-211-0966 .
- Diamond State Health Plan-Plus: 1-855-777-6617 .
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What Is A Services Card
About 7-10 days after youre found eligible for Apple Health coverage, a services card will be mailed to you. This is a plastic ID card that looks similar to other health insurance ID cards. Take this card with you to your doctor appointments. Providers use this card to make sure your service is covered.
If I Am Pregnant Will I Still Be Able To See The Same Doctor
Yes, as long as your current doctor accepts Peach State Health Plan. Remember that because you are pregnant you will have 2 doctors. One doctor is your PCP. The second doctor is your OB/Gyn. Your OB/Gyn will not appear on your Peach State Health Plan ID card. Only your PCP will appear on your Peach State Health Plan ID card. You can keep your current OB/Gyn as long as they accept Peach State Health Plan.
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What If I Think A Decision You Make Is Unfair Incorrect Or Made Too Late
You have the right to appeal the Medicaid decision. There are several ways to request an appeal. You can write the reason you disagree with the decision on the back of the decision letter and then mail or fax it to Medicaid as directed on the letter. You can also fax the decision letter to the Division of Administrative Law at 225-219-9823 or mail it to the Division of Administrative Law, Department of Health Section, P. O. Box 4189, Baton Rouge, LA 70821-4183. You can request an appeal by phone by calling Medicaid Customer Service at 1-888-342-6207 or the Division of Administrative Law at 225-342-5800.
Will Medicaid Provide Payment For A Family Member Who Needs Nursing Home Care
Louisianas Medicaid Program provides payment for special long term care support services, as well as full Medicaid health coverage, to eligible people who, because of their medical condition, require assistance with activities of daily living . Long-term care supports may be provided either in a facility or in an individuals own home or in the community. Visit Medicaid Long-Term Care.
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How Does Medicaid Work
The Medicaid program does not provide health care services for everyone. Your application will be reviewed for all Medicaid programs. If you are found eligible for Medicaid, you will get:
- A letter in the mail from Medicaid telling you about your coverage
- A Medicaid ID card
- A Healthy Louisiana plan ID card, if you enroll in a plan.
Each time you go to your health care provider or pharmacy, take your Medicaid ID and Healthy LA plan ID cards with you. Show them at all medical visits before you receive any service. The health care provider or pharmacy will tell you if they accept your Medicaid benefits. You should also ask your health care provider or pharmacy if the service or prescription is covered by Medicaid before receiving the service or filling a prescription.
Medicaid does not pay money to you instead, it sends payments directly to your health care provider or pharmacy.
What Is Medicaid Card Fraud And What Do I Do If It Happens
Medicaid card fraud is something that happens somewhat frequently to almost every Medicaid recipient at some point or another. While some unfortunate individuals experience a form of identity theft, other people unknowingly encourage Medicaid fraud. One of the most commonly seen cases of Medicaid fraud occurs when a Medicaid recipient shares their Medicaid ID number or card with a friend or family member in an effort to help this other person. Unfortunately, although the Medicaid recipient is trying to do something positive by helping out someone they care about, this form of Medicaid fraud can have serious repercussions.
Some examples of reasons why a Medicaid recipient might willingly share their Medicaid card or ID number include:
Desire to help a family member or friend in need who does not have insurance coverage
Participation in selling or trading the Medicaid card or number in exchange for money or items
To protect themselves and/or family members if someone threatens to harm them if they do not share their Medicaid card or ID number
Medicaid recipients may also unwillingly become victims of Medicaid card fraud. Some situations where a Medicaid recipient may experience fraud include:
Other people stealing Medicaid cards and numbers from beneficiaries
Individuals who buy Medicaid cards and numbers from beneficiaries or who offer free gifts or services in exchange for these cards and numbers
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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.
