Medicaid Managed Care

How do I know if I can sign up for a Medicaid Managed Care health insurance program?

To sign up for a Medicaid Managed Care program, you may already get these types of help from New York State:

• Temporary Assistance to Needy Families (TANF)
• Health coverage from Medicaid ONLY (MA-ADC)
• Extra income from Safety Net Assistance (SNA) and Supplemental Security Income (SSI)

You must also live in the Healthfirst service area:

• New York City (Manhattan, Bronx, Brooklyn, Queens or Staten Island) or Long Island (Nassau and Suffolk counties)

If you have Medicaid, you may have to join a Medicaid Managed Care Program. You will receive a notification from New York Medicaid CHOICE. If you don’t choose a health plan, one may be chosen for you. Don’t let others make your choice. Choose Healthfirst.

What will I get from Healthfirst’s Medicaid Managed Care program?

Benefits include, but are not limited to:

• Regular doctor visits, such as your yearly physical, to make sure you stay healthy.
• Health screenings, such as blood tests or x-rays, to catch health problems at early stages so they are easier to treat.
• Yearly exams, birth control, and full pregnancy care for women (OB/GYN visits).
• Hospital services – both inpatient and outpatient.
• Complete medical care for infants and children including baby and toddler shots (immunizations/vaccines) and regular pediatrician visits.
• Dental, vision, and hearing care.

> Download the full benefits for this program

> Learn more about the Medicaid Managed Care program.
> How much does Medicaid Managed Care cost per month?
> Full benefits for the Medicaid Managed Care program
> Important forms and information

I have questions. I’m not sure if I can get Medicaid Managed Care.
We’re here to help! If you do not qualify for Medicaid Managed Care, you may be able to get Family Health Plus or another Healthfirst health insurance program. Contact a Healthfirst representative to ask questions and pick the best health program for you or your child.

You are eligible for Medicare if:

• You or your spouse worked for at least 10 years in Medicare-covered employment.
• You are 65 years or older and a citizen or permanent resident of the United States.

You may be eligible if:

• You aren’t 65 yet, but you are disabled.
• You have end-stage renal disease (permanent kidney failure requiring dialysis or transplant).

> Learn more about our Medicare plans
> Important materials and forms
 

To qualify for Healthy NY insurance, you must meet the following requirements:

• You must live in New York State.

• You or your spouse must have a job, or have had a job in the past year.

• Your employer does not “provide” you with health insurance right now.
• "Provide” means offering health insurance AND paying some or all of the costs.
• You have not had health insurance for the past year.
• You have lost insurance because of a “specific event.”

            What is a specific event?

• Loss of your job
• Death of a family member
• Change to a new job
• Changing where you live
• Group health plan has ended
• COBRA coverage has ended or been cancelled
• Public health insurance program (such as Medicaid or Family Health Plus) has ended
• Legal separation, divorce, or marriage annulment
• You no longer qualify for group health insurance coverage.
• You are too old to be covered under your parents’ health insurance.
• You must not qualify for Medicare, due to age or disability.

Healthy NY benefits include:

• Maternity care.
• Adult preventive services, such as mammograms, pap smears, physical examinations once every 3 years, and adult immunizations.
• Preventive and primary health care services for dependent children, including routine checkups for your child and immunizations (vaccines).
• Diabetes equipment, supplies, and self-management education.
• Tests, x-rays, and laboratory services.
• Emergency services.
• And much more.

> Download a full list of Healthy NY benefits