Ny Medicaid Phone Number For Providers

Date:

What Does A Managed Long

New Provider/New Biller — Medicaid Partners

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.

New York Independent Assessor Mmc Guidance And Member Notice

  • PDF 726.75KB – Last Updated: 05/19/2022

Notice:

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 2.14MB – Last Updated: 07/01/2022

Spring

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Winter

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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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How Can You Apply

You or your authorized representative can apply by mailing in an application to the address below:

Initial Eligibility Unit HRA/Medical Assistance Program PO Box 24390 Brooklyn, NY 11202-9814

You can also fax your application to 917-639-0732. Your authorized representative can fax an application to 917-639-0731.

You or your authorized representative can also apply at any local Medicaid office within New York City. You can call 311 for the nearest Medicaid Office, or visit our Medicaid Office page for the complete list.

For help applying, please see this list of facilitated enrollers.

For more information, call the Medicaid Helpline at 1-888-692-6116 or visit the NYS website.

Where Can Enrollment Forms Be Obtained

Blue Cross Blue Shield Pharmacy Number
  • At a New York Medicaid Choice education and enrollment session at the DSS center in Uniondale or call New York Medicaid Choice to request an enrollment packet
  • A health plan marketing representative can supply the enrollment form. A consumer can request this form directly from the marketing representative or they can call the health plan of choice.

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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.

Useful Websites And Phone Numbers

STATEWIDE RESOURCESADAPAyuda Legal NY

Child Health Plus : 1-800-698-4KIDS

CuidadoDeSalud.gov is a Federal government website in Spanish to provide consumers with both public and private health coverage options tailored specifically for their needs in a single, easy-to-use tool. This is the Spanish version of HealthCare.gov. CuidadoDeSalud.gov offers an insurance finder, explains the Affordable Care Act in step-by-step detail and offers information for families with children, senior citizens, people with disabilities and others.

EPIC: 1-800-332-3742,

EnrollNY: Website that allows applicants for Medicaid, Family Health Plus, and Child Health Plus to be screened for these programs, begin an application online, and have their applications forwarded to facilitated enrollers to complete the application process and be enrolled in a managed care plan. Provided by the Hudson Center for Health Equity & Quality.

HIICAP NOTEBOOK – Annually updated comprehensive guide to Health Care in NYS for seniors and people with disabilities. Covers Medicare, Medicaid, EPIC, Medigap and other topics. More on HIICAP Counselors Corner.

NY State of Health

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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.

Unitedhealthcare Senior Care Options Plan

Star Plus – Medicare Medicaid

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.

Read Also: How Can I Check If I Have Medicaid

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.

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.

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Are You A Person With A Disability Who Is Working

The Medicaid Buy-In program offers coverage to people with disabilities who are working and earning more than what is allowed in traditional Medicaid.

To qualify you must meet all the following requirements:

  • Be a resident of New York City
  • Be between 16-64 years of age
  • Have a disability as defined by the Social Security Administration or by New York State
  • Be working
  • Have resources not exceeding $20,000 for an individual and $30,000 for a couple
  • Have an income below 250% of the federal poverty level . However, the way income is calculated allows you to earn more than the FPL and still be eligible. For example, in 2021, 250% of the FPL was around $32,208, but people with $65,436 in earned income could still be eligible. You can use the Income Test Worksheet on page 6 of the toolkit for the MBI-WPD program to get a better sense of whether you might be eligible at your income level.

What Is Managed Care

Nys Medicaid Managed Care Pharmacy Benefit Information

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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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.

Are You Already Getting Insurance Through Your Employer

If you have health insurance coverage through your employer, you should keep that insurance and reach out to HRA. Medicaid may cover the cost of the premium for that insurance coverage.

The MBI-WPD program does not offer family coverage. Single people and married couples are both covered under this program if both individuals are working and have a disability. Spouses without a disability and children may be covered through other programs such as Medicaid through New York State of Health or Child Health Plus.

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/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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Ny Medicaid Phone Number For Providers

Free In NYC: Medicaid Excess Income

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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.

Unitedhealthcare Dual Complete Plans

Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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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

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Medicaid Beneficiaries

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.

Dental Care That Keeps You Smiling

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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.

How To Apply For Ny Medicaid

You may apply for Medicaid in the following ways:

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 and not eligible for Medicare,
  • Children 1 – 18 years of age
  • Pregnant Individuals,
  • Parents and Caretaker Relatives of any age

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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