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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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.
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.
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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.
See Why New Yorkers Choose Unitedhealthcare
- 800 languages are spoken in New York City more than any other city in the world and 4 in 10 households speak a language other than English
- The diversity of our employees helps us build strong relationships in the communities we serve, to help our members live healthier lives
- Large variety of network providers
- No-cost virtual visits
- Prescription drugs
Make sure your primary care provider is correct. The PCP listed on your member ID card is your assigned PCP. If you change your PCP, please contact Member Services. Well send you a new card with the updated PCP information.
Join the community wherever you are. Visit . The page includes ideas and insights for healthy living, and gives you a chance to connect with other members.
Its your health. Its your choice.
Everyone deserves affordable health care, including you.
Working adults who dont qualify for Medicaid may qualify for the Essential Plan. Check out the Essential Plan offered through the New York State of Health by UnitedHealthcare to see if youre eligible.
We have the coverage, benefits and extras that can make a real difference in your life. All at either a low cost or no cost to you.
- Open enrollment all year long
- No referrals needed for specialist
- Dental coverage
- Vision coverage
Sometimes, you might need a little extra help. If you arent eligible for Medicaid, the Essential Plan could be the right fit for you.
We also offer resources to help you make the most of your plan. Including:
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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 plans member services dept.
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.
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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.
Nys Medicaid Managed Care Pharmacy Benefit Information Center Faqs
Abbreviated New Drug Application :
What if a drug is not listed on a health plans 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 plans 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?
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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:
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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
- 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.
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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
How To Contact The Customer Service Center
NY State of Health lets you shop for, compare, and buy a health plan online, in-person or over the phone. We offer expert helpers for every step of the process. Trained representatives are ready to answer questions and provide information to consumers and small businesses. You can reach NY State of Health by calling us toll free at 1-855-355-5777 .
The Customer Service Center hours of operation are:
Monday – Friday 8am-8pmSaturday – 9am-1pmIf you have questions about health plans, financial assistance, or anything else about NY State of Health please contact our Customer Service Representatives at 1-855-355-5777. Information is also available throughout this website.
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Where Can Enrollment Forms Be Obtained
- 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.
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.
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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
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 Countys 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 plans benefit package.
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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.
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Think You Might Qualify For A Plan Find Out How
Were here to help you find the right plan for you and your family.
If you live in Albany, Columbia, Dutchess, Genesee, Greene, Jefferson, Lewis, Livingston, Monroe, Oneida, Ontario, Orange, Putnam*, Rensselaer, Saratoga, Schenectady, Sullivan, Rockland, Ulster, Warren, Washington or Westchester counties:
- Call MVP Health Care at 1-800-825-5687
- Monday Friday from 8 am to 6 pm
If you live in a county that is not listed above, please contact the New York State Department of Health to learn more about the Medicaid options in your area.
*Essential Plan not available in Putnam county.
Dual Special Needs Plans In 2022
New Yorkers on a UnitedHealthcare Dual Special Needs Plan get many extra benefits beyond those you get with either Original Medicare or Medicaid.
- Dental coverage Up to $1,000 for covered dental such as certain exams, cleanings and fillings
- Prescription drug coverage $0 copay on covered generic and brand-name prescriptions including home delivery
- OTC+ Health Food $50 a month on a prepaid card for OTC and covered groceries in-store or online
- Renew Active® A fitness program for body and mind, at no additional cost
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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.
Announcing A New Foster Care Transition To Medicaid Managed Care
Starting , MetroPlusHealth will cover Article 29-I Voluntary Foster Care Agency Health Facility services for children and youths under age 21 in foster care and other special populations, as indicated.
Also starting , some children and youth must join a Medicaid managed care plan, including:
- children and youth placed in foster care in New York City, and
- children and youth placed in foster care and a 29-I VFCA Health Facility
Some children and youth placed in foster care cannot join a Medicaid managed care plan. They will keep getting services through regular Medicaid.
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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
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, or use your preferred relay service 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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Institution For Mental Disease In Lieu Of Service Benefit
Institution for Mental Disease In Lieu of Service Benefit information
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PDF 39.88KB Last Updated: 11/12/2020
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 facilitys 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.
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