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