New York Medicaid Expansion

New York is fully participating in the Medicaid Expansion under provisions of the Affordable Care Act (ACA). For additional background on the State’s policy decisions regarding the Medicaid Expansion option, see: Background.

Medicaid in New York

The NY Department of Health administers the state’s Medicaid program. Information about the state Medicaid program, including beneficiary information, can be found at: http://www.health.ny.gov/health_care/medicaid/.

Provider Participation

Providers must enroll in the Medicaid fee-for-service program to receive payments for covered services. Information about enrolling in the Medicaid fee-for-service program can be found at: http://www.health.ny.gov/health_care/medicaid/.
The NY Medicaid website provides information about services covered by fee-for-service payments and payment amounts: http://www.health.ny.gov/health_care/medicaid/.
In order to retain access to all Medicaid patients in the state, providers must also connect to the managed care plans individually

Medicaid Managed Care

Some Medicaid beneficiaries are enrolled in managed care plans. Basic information about the Managed Care Program can be found at: http://www.health.ny.gov/health_care/managed_care/mamctext.htm.
Some managed care plans cover individual New York counties and independent cities. The Medicaid website has jurisdictional information: http://www.health.ny.gov/health_care/medicaid/.

Medicaid Beneficiaries Participating in Managed Care

Managed care plans participating in the NY Managed Care Program offer detailed information about covered benefits for individuals enrolling in their plans. This information is available on the managed care websites shown below.

Reporting Problems

The state Medicaid office is primarily responsible for examining and addressing issues with the Medicaid Managed Care plans offered in the state, and for working with the companies that offer them. If you are experiencing problems as a medical provider with the Managed Care plans or companies operating in the state, or if your patients are experiencing problems with the Managed Care plans or companies in the state, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any other problems related to the Affordable Care Act, please report these problems to the state Medicaid Office:

http://www.health.ny.gov/health_care/medicaid/

800-541-2831
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.

Managed Care Plans Participating in Managed Care Program

Aetna Health, Inc.
Plan Website: http://www.aetna.com/individuals-families-health-insurance/plans-benefits/medicaid/index.html
Provider Enrollment: http://www.aetna.com/healthcare-professionals/join-aetna-network/join-provider-network.html

Affinity Health Plan, Inc.
Plan Website: http://www.affinityplan.org/
Provider Enrollment: http://www.affinityplan.org/Affinity/Providers/Credentialing.aspx

Amerigroup NY
Plan Website: https://www.myamerigroup.com/English/Medicaid/ny/Pages/NewYork.aspx
Provider Enrollment: https://providers.amerigroup.com/Pages/NY.aspx

Amida Care, Inc. Special Needs Plan
Plan Website: http://www.amidacareny.org/
Provider Enrollment: http://www.amidacareny.org/providers-why-participate-provider-network.htm

Atlantis Health Plan
Plan Website: http://www.atlantishp.com/
Provider Enrollment: http://www.atlantishp.com/Join.asp

Capital District Physician’s Health Plan(DPHP)
Plan Website: http://www.cdphp.com/Members/Health-Plan/Government-Plans/Medicaid-Select-Plan
Provider Enrollment: http://www.cdphp.com/en/Providers/Get-Your-Job-Done/Provider-Benefits

Empire HealthChoice HMO, Blue Cross Blue Shield
Plan Website: http://www.empireblue.com/wps/portal/ehpmember?content_path=member/noapplication/f3/s2/t4/pw_ad067434.htm&label=Healthy%20New%20York
Provider Enrollment: http://www.empireblue.com/home-providers.html

Excellus Health Plan, Blue Cross Blue Shield
Plan Website: https://www.excellusbcbs.com/wps/portal/xl/inp/healthplans/bluechoiceoption/
Provider Enrollment: https://www.excellusbcbs.com/wps/portal/xl/!ut/p/b1/04_Sj9CPykssy0xPLMnMz0vMAfGjzOJDDByDzM193IJNTNxDDAxNQ3wtDCAAqCASqMDdyyzYxcvSyczJxNfAzMvFKMAApoAo_QY4gCNB_X4e-bmp-gW5oRHljoqKAJP9DbM!/dl4/d5/L2dJQSEvUUt3QS80SmtFL1o2X1RVUjRMN0gyMDgxMTcwSTYwTk5FVlEwMDgw/

Health Insurance Plan of NY, EmblemHealth
Plan Website: http://www.emblemhealth.com/
Provider Enrollment: http://www.emblemhealth.com/Providers

Health Net of NY, Inc.
Plan Website: http://www.healthnet.com/
Provider Enrollment: https://www.healthnet.com/portal/provider/content/iwc/provider/unprotected/working_with_HN/content/network_participation_request.action

HealthFirst Prepaid Health Services Plan (PHSP), Inc.
Plan Website: http://www.healthfirstny.org/
Provider Enrollment: http://www.healthfirstny.org/providerservices

HealthNow NY, Blue Cross Blue Shield of Western New York
Plan Website: https://securews.healthnowny.com/web/content/HNNY_brochure/home.html
Provider Enrollment: https://securews.healthnowny.com/web/content/HNNY_provider/home/network-participation/credentialing.html

Hudson Health Plan
Plan Website: http://www.hudsonhealthplan.org/visitors/our-programs/medicaid-managed-care/
Provider Enrollment: http://www.hudsonhealthplan.org/providers/become-provider/

Independent Health Association, Inc.
Plan Website: https://www.independenthealth.com/portal/site/IndependentHealth/;jsessionid=wd7GR9CV1cFnvQJRVQ4g1LCxSmRDzG72KwF59nph6HFQNrjlqr9K!-1338868448!NONE
Provider Enrollment: https://www.independenthealth.com/portal/site/footer/menuitem.2ba8fb86becf8b6a818e6c1020a08a0c/?vgnextoid=daf67ded4cf2f110VgnVCM100000113110acRCRD

Managed Health, Inc.
Plan Website: http://www.healthfirstny.org
Provider Enrollment: http://www.healthfirstny.org/providerservices

MetroPlus Health Plan
Plan Website: http://www.metroplus.org/mpp_medicaid_managed_care.php
Provider Enrollment: https://intranet.metroplus.org/EmailUs/ProviderContact.aspx

MetroPlus Health Plan Special Needs Plan
Plan Website: http://www.metroplus.org/mpp_partnership_in_care.php
Provider Enrollment: https://intranet.metroplus.org/EmailUs/ProviderContact.aspx

MVP Health Plan, Inc.
Plan Website: https://swp.mvphealthcare.com/wps/portal/mvp/home/members/plans/insuranceind/option
Provider Enrollment: http://www.mvphealthcare.com/provider/index.html

Neighborhood Health Providers NY, Healthfirst
Plan Website: http://www.healthfirstny.org/
Provider Enrollment: http://www.healthfirstny.org/providerservices

NY State Catholic Health Plans, Fidelis Care
Plan Website: http://www.fideliscare.org/
Provider Enrollment: http://www.fideliscare.org/providers.aspx

Oxford Health Plans, Inc., United Healthcare
Plan Website: https://www.oxhp.com/
Provider Enrollment: https://www.oxhp.com/ProviderPortal

SCHC Total Care
Plan Website: http://www.totalcareny.com/
Provider Enrollment: http://www.totalcareny.com/default.aspx?PageID=817

United Healthcare of NY, DBA AmeriChoice by United Healthcare, DBA United Health Care Community Plan
Plan Website: http://www.uhccommunityplan.com/plan/state/NY/index
Provider Enrollment: http://www.uhccommunityplan.com/physicians-network

Univera Community Health Universal Healthcare
Plan Website: http://www.univeracommunityhealth.org/pm.asp
Provider Enrollment: http://www.univeracommunityhealth.org/providers.asp#6

Visiting Nurse Service of NY Choice Special Needs Plan
Plan Website: http://2013.vnsnychoice.org/what-is-vnsny-choice/medicaid-and-medicare/
Provider Enrollment: http://2013.vnsnychoice.org/vnsny-choice-selecthealth/providers/

WellCare of NY
Plan Website: https://newyork.wellcare.com/
Provider Enrollment: https://newyork.wellcare.com/provider/default