Medicaid Chronic Care Nursing Home Placement
- Placement of Albany County residents in Nursing Homes
- Pickup of Albany County residents already in Nursing Homes
- Long Term Home Health Care cases Married couples where one is looking for a waiver program:
- Nursing Home Transition Diversion or Traumatic Brain Injury or to enroll in a Managed Long Term Care Plan . This allows a spouse to receive care at home and still qualify for Medicaid.
Please call the above number for further information.
Mental Health/substance Use Disorder
Addiction can happen to anyone, any family, at any time according to the New York State Office of Alcoholism and Substance Abuse Services .
UnitedHealthcare is here to assist you in all your healthcare needs. We have trained professionals who are experienced in understanding Substance Use Disorder and able to help you get treatment or give you information that will help you make decisions about your healthcare. You or your provider can call Optum Behavioral Health anytime for help at
Covered services include:
- All inpatient mental health and substance use disorder services .
- Most outpatient mental health services .
- Medicaid recipients who receive SSI or who are certified blind or disabled get mental health and substance use disorder services from any Medicaid provider by using their Medicaid Benefit Card.
- Detoxification services are covered by UnitedHealthcare Community Plan as a benefit.
Adult Care And Assisted Living
- AIDS Drug Assistance Program 1-800-542-2437
- NYS After Hours Hotline 1-800-872-2777
- Physician referring patient to RPCI
- Diagnosis or suspicion of cancer or want 2nd opinion
- General or specific question about cancer or learn about trials
- Will your insurance cover costs at RPCI
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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
Information Needed To Apply
To apply, you will need the following information for all applicants, spouse and parents of applying children:
- All household income and employer information including:
- pay stubs
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What Does A Managed Long
A Long Term Care Plan provides services to people with a disability or long-lasting health problem. Your plan will make sure you get the long term care services you need. Long term care includes help with day-to-day and personal activities, home health aides, adult day health, and other services. You will continue to use your Medicaid card for any services no covered by your Managed Long-Term Care Plan.
How Does One Know That The Enrollment Is Complete And They Can Start Using The Plan
- New York Medicaid Choice will send a notice.
- The selected managed care plan will send the new enrollee a Member ID card directly to them along with a welcome letter and a plan handbook explaining the benefits.
- New York Medicaid Choice – 1-800-505-5678
- Contact the individual plan’s member services dept.
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Nys Medicaid Managed Care Pharmacy Benefit Information Center Faqs
Abbreviated New Drug Application :
What if a drug is not listed on a health plan’s formulary?
Drugs that are not listed on a health plans formulary may be either non-formulary or covered as a medical benefit. Non formulary drugs may be covered if the provider or member requests coverage. The process for submitting a request for covering a drug that is not on the health plans formulary or determining if a drug is covered as a medical benefit can be found by contacting the health plan or accessing theirweb site.
How is a formulary developed/changed?
In most health plans, the formulary is developed by a pharmacy and therapeutics committee made up of pharmacists and physicians from various medical specialties. The committee reviews new and existing medications and selects drugs to be in the health plan’s formulary based on safety and how well they work. The committee then selects the most cost-effective drugs in each drug class. A drug class is a group of drugs that treat a specific health condition or that work in a certain way.
Are there any drug classes or types of drugs that are not covered?
Can health plans set quantity limits?
What is step therapy?
Step therapy is when the health plan requires that one or more lower cost drugs in the same drug class or in a proven clinical alternative drug class be tried before they will cover the requested drug.
What is prior authorization ?
How long does the PA process take?
Where can I find prior authorization forms?
What Do I Need To Apply
The necessary documentation needed to apply for Medicaid also depends on your category, specifically whether you fall under the Modified Adjusted Gross Income or non-MAGI guidelines. These guidelines are defined in the section below.
MAGI eligibility groups include:
- Pregnant women
- Infants and children under 19 years of age
- Childless adults who are not pregnant, 19-64 years of age, not on Medicare, and could be certified disabled but not on Medicare
- Parents/caretaker relatives
- Family Planning Benefit Program and/or
- Children in foster care
Non – MAGI Eligibility Groups include:
- Individuals 65 years of age or older, who are not a parent or caretaker relative,
- individuals who are blind or disabled who do not meet the criteria of any of the MAGI eligibility groups
- Residents of Adult Home run by LDSS, OMH Residential Care Centers/Community Residences
- Individuals eligible for the following programs:
- AIDS Health Insurance Program
- Medicaid Buy-in Program for Working People with Disabilities
- Medicaid Cancer Treatment Program
Application for Non-MAGI
The following paper application may only be printed and completed if you are applying at an LDSS for Medicaid because you are over 65 years of age or an individual in your household is deemed certified blind or disabled, or you are applying for Medicaid with a spenddown.
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New York Medicaid Office
Below is the contact information for the Medicaid office in New York. They can assist you with questions or concerns about the New York Medicaid program, including the eligibility requirements and Medicaid enrollment in New York. You can view their site online at omig.ny.gov. To find out if you are eligible for this program, New York Medicaid eligibility.
The Medicaid program in New York covers basic medical care. This may include doctor services, inpatient hospital care, laboratory and x-ray services, inpatient short-term skilled nursing or rehabilitation-facility care, outpatient hospital or clinic care, short-term home healthcare, ambulance service and prescription drugs for people not covered by Medicare. We suggest contacting the Medicaid office to find out specifically what coverage is provided as it can be different in each state.
How Do I Apply
If you apply at one of our Department of Community and Family Services locations, you will need the following documents:
- If you are a U.S. citizen and provide a valid Social Security Number , a match with the Social Security Administration will verify your SSN, date of birth, and U.S. citizenship. If SSA verifies this information, no further proof is needed. The SSA match cannot verify birth information for a naturalized citizen. You will need to submit proof of naturalization or a U.S. passport.
- Proof of citizenship or immigration status.
- Proof of age , like a birth certificate.
- Four weeks of recent paycheck stubs .
- Proof of all your income including sources like Social Security, Veteranâs Benefits , retirement benefits, Unemployment Insurance Benefits , Child Support payments.
- If you are age 65 or older, or certified blind or disabled, and applying for nursing home care waivered services, or other community based long term care services, you need to provide information of all bank accounts, insurance policies and all other resources.
- Proof of where you live, such as a rent receipt, landlord statement, mortgage statement, current utility bill or envelope from mail you received recently.
- Copy of insurance benefit cards .
- Copy of Medicare Benefit Card .
Note: Medicaid coverage is available, regardless of alien status, if you are pregnant or require treatment for an emergency medical condition and you meet all other Medicaid eligibility requirements.
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American Disabilities Act Notice
In accordance with the requirements of the federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973 , UnitedHealthcare Insurance Company provides full and equal access to covered services and does not discriminate against qualified individuals with disabilities on the basis of disability in its services, programs, or activities.
Medicaid Buy In Program For Working People With Disabilities And Medicare Savings Programs
The Medicaid Buy-In Program for Working People with Disabilities provides Medicaid coverage for people ages 16-64 who have a disability and are engaged in a work activity for which they are paid. In order to be considered for this program, the individual must be determined disabled as defined by the Social Security Administration. The persons net income must be at or below 250% of the federal poverty level.
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How Will The Consumer Choose A Plan
- If the consumer has a primary care provider who belongs to any Nassau County contracted health plan, they can choose that plan.
- They can call any doctor. If that doctor belongs to any Nassau County contracted health plan, they can choose that one.
- They can look at the list of providers for each health plan and choose from the list.
- If the consumer does not choose a health plan voluntarily within 60 days of notice to do so, they will automatically be assigned to a health plan.
New York Health Plan Support
Contact information listed below is specific to New York health plans.
Enterprise Voice Portal
- Advance Notification, Prior Authorization and Admission Notification
- Fraud, Waste and Abuse
- Outpatient Radiology Notification & Authorization – Submission and Status
- Provider Relations
What You Can Do When Calling this Number:
- Inquire about a Customers eligibility or benefits and obtain a faxed confirmation.
- Check claim status, reason code explanation and claim spending and mailing addresses.
- Update facility/practice demographic data .
- Check credentialing status or request for participation inquiries.
- Check appeal or claim project submission process information.
- Check care notification process information.
- Check privacy practice information.
What You Can Do When Calling this Number:
- Cardiology Notification & Authorization Submission and Status
- Chemotherapy Prior Authorization Program
- Therapeutic Radiation Prior Authorization
Phone Number: 800-873-4575
What You Can Do When Calling this Number:
- Chiropractic, Physical Therapy, Occupational Therapy, and Speech Therapy Providers contracted with OptumHealth Physical Health, a UnitedHealth Group company
Phone Number: 800-711-4555
- OptumRx Fax : 800-527-0531
- OptumRx Fax : 800-853-3844
Urgent Appeal Submission
Phone Number: 866-842-3278, Option 1
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Unitedhealthcare Connected 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 , TTY 711, 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 , TTY 711, 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.
Los servicios Language Line están disponibles para todos los proveedores dentro de la red.
No Existing Medicaid Coverage
If you dont already have Medicaid coverage, and you meet the above conditions, you may ask to have your Medicaid application processed more quickly by sending in a completed Access New York Health Insurance Application and the Access New York Supplement. If needed, you will also need to provide a physicians order for services and a signed
Attestation of Immediate Need.
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Institution For Mental Disease In Lieu Of Service Benefit
Institution for Mental Disease In Lieu of Service Benefit information
PDF 39.88KB – Last Updated: 11/12/2020
New York State Department of Health has stated Medicaid recipients should receive breast cancer surgery services at high volume facilities .
See the listing of low-volume facilities that will not be reimbursed for breast cancer surgeries provided to Medicaid recipients.
This policy does not affect a facility’s ability to provide diagnostic or excisional biopsies, and postsurgical care for Medicaid patients.
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 or call our Member Services at 1-800-493-4647 to request a printed copy.
PDF 2.36MB – Last Updated: 10/13/2021
PDF 1.97MB – Last Updated: 07/06/2021
PDF 6.45MB – Last Updated: 03/18/2021
PDF 7.17MB – Last Updated: 01/05/2021
What Is Managed Care
Managed Care is a comprehensive health care program which integrates the services of doctors, hospitals, and health care specialists into a health plan network whose goal is to manage the health care of its enrollees. Under managed care, Medicaid beneficiaries are entitled to the same benefits as fee-for-service Medicaid, but receive them through their managed care plan.
Nassau has seven health plans available to Medicaid beneficiaries – AFFINITY, FIDELIS, HIP/EMBLEM, HEALTHFIRST, EMPIRE BLUECROSS BLUESHIELD HEALTHPLUS, AMERICHOICE BY UNITED HEALTHCARE, AND WELL CARE.
- Medicaid recipients without a spenddown
- SSI recipients
In July, 1997, the federal government granted New York State a “waiver” permitting the State to require all Medicaid beneficiaries join a Medicaid Managed Care Plan. There are many Medicaid consumers who voluntarily enroll in the County’s Managed Care Program. The County has completed the required review process with New York State and the Federal Government, which allows for mandated enrollment of medicaid recipients into its’ managed care program. Mandatory enrollment in the County started in 2001.
Will Medicaid benefits change? No, But the client will need to use their Medicaid card for any services that are not included in the plan’s benefit package.
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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. .
Empire Offers These Benefits To Kids Families And Adults In New York Through Medicaid Child Health Plus And The Essential Plan
- You live in New York
- Your family income is less than the amount below
Who needs health insurance?
How many people live in your house?
You may qualify if your monthly income is less than:
Please make your selections above
Children under age 19 may qualify for CHPlus at higher income levels, but will pay the full monthly premium amount.
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Immediate Need For Personal Care Services / Consumer Directed Personal Assistance Services
If you think you have an immediate need for Personal Care Services or Consumer Directed Personal Assistance Services , such as housekeeping, meal preparation, bathing, or toileting, your eligibility for these services may be processed more quickly if you meet the following conditions:
- You are not receiving needed help from a home care services agency
- You have no adaptive or specialized equipment or supplies in use to meet your needs
- You have no informal caregivers available, able and willing to provide or continue to provide care
- You have no third party insurance or Medicare benefits available to pay for needed help