COVID-19 Guidance for Medicaid Providers

The following guidance has been issued in response to the current novel coronavirus (COVID-19) outbreak.

The health and safety of healthcare workers and our ability to provide and support patient care remain our priorities. Recently, community-wide transmission of COVID-19 has occurred in the United States (US) including New York State, and the number of both Persons Under Investigation (PUIs) and confirmed cases are increasing in NYS. The situation with COVID-19 infections identified in the United States continues to evolve and is very rapidly changing. It is important for all agencies to keep apprised of current guidance by regularly visiting the Centers for Disease Control and Prevention (CDC) and NYSDOH websites, as well as the NYSDOH Health Commerce System (HCS), for the most up-to-date information for healthcare providers.

COVID News and Updates
  • Reopening Guidance for Medical Model Adult Day Health Care Program (PDF) - 3.25.2021
  • NYS Medicaid Redesign Team (MRT) Waiver COVID-19 1115-a Demonstration Request:
  • Medicaid 1915(c) Appendix K
  • Medicaid 1135 Waiver Request - (Web) - (PDF) - 3.23.2020
COVID Fact Sheets for Medicaid Consumers
  • Medicaid Coverage through Your Local Department of Social Services (LDSS) during the Coronavirus Emergency - May 2020
  • Medicaid Telehealth Services During the Coronavirus Emergency - May 2020
Guidance Materials

The following guidance documents are effective immediately and shall remain in effect for the remainder of the disaster emergency declared by Executive Order No. 202, or until the issuance of subsequent guidance by the NYSDOH prior to the expiration of such state disaster emergency declaration.

  • Coverage Policy and Billing Guidance for the Administration of COVID 19 Vaccines Authorized for Emergency Use - (Web) - (PDF) Updated 5.13.21
  • COVID-19 Vaccine Administration Billing Guidance for Managed Long-Term Care Members without Medicare Coverage - (Web) - (PDF)
  • New York State (NYS) Medicaid Billing Guidance for COVID-19 Testing and Specimen Collection and Monoclonal Antibody Infusions - (Web) - (PDF) (Updated 4.23.21)
  • New York State (NYS) Medicaid Fee-For-Service (FFS) Policy and Billing Guidance for COVID-19 Testing and Specimen Collection at Pharmacies - (Web) - (PDF) - 5.22.20 (Updated 2.18.21)
  • COVID-19 HCBS Respite Guidance (Web) - (PDF) - April 8, 2020 (Updated 6.26.2020)
  • CMS APPROVED 1915c Children Waiver Appendix K Amendment for COVID-19 - (PDF) - 6.18.20
  • Questions and Answers Related to COVID-19 Guidance for Providing Adult Social Day Care (SDC) Services Telephonically (Web) - (PDF) - 5.16.2020
  • Medicaid Update Special Edition: Comprehensive Telehealth Guidance (Web) or (PDF) (published: 5/1/2020, revised: 5/29/20).
    • Frequently Asked Questions (FAQs) on Medicaid Telehealth Guidance during the Coronavirus Disease 2019 (COVID-19) State of Emergency - (Web) - (PDF) - Updated 5.1.2020
    • Webinar: New York State Medicaid Guidance Regarding Telehealth, Including Telephonic, Services During the COVID-19 Emergency - 5.5.2020
  • COVID-19 Guidance for Voluntary Plan of Care Schedule Change - (Web) - (PDF) - 4.23.20
  • Medicaid Update Special Edition: New York State Medicaid Program Launches Online Medicaid Provider Enrollment During COVID-19 Public Health Emergency - (Web) or (PDF) - 4.20.2020
  • COVID-19 Guidance for Managed Care Organization Contracting and Surveillance Relief - (Web) - (PDF) - 4.8.20
  • Guidance on Providing Adult Social Day Care (SDC) Services Telephonically - (Web) - (PDF) - 4.7.2020
  • Guidance on Frequently Asked Questions (FAQ) from Non-Emergency Medical Transportation (NEMT) Providers - (Web) - (PDF) - 4.7.2020
  • Guidance on Suspended Health Plan Utilization Review Requirements - (Web) - (PDF) - 4.3.2020
  • Guidance for 1915(c) HCBS Children´s Waiver for Children´s Health Homes and Children, Youth Evaluation Services (C-YES), HCBS Providers, and MMCP/HIV SNP - (Web) - (PDF) - 3.29.2020
  • COVID-19 Telephonic and Telehealth Services Available to Statewide Adult Day Health Care Program Services - (Web) - (PDF) 03.28.20
  • Guidance on Medicaid Changes to Private Duty Nursing (PDN) Policy - (Web) - (PDF) - 3.28.2020
  • Guidance on Medicaid Changes to Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Policy - (Web) - (PDF) - 3.28.2020
  • Guidance for Infection Control in NYS DOH Supportive Housing Programs in Response to COVID-19 (Web) - (PDF) - 3.27.2020
  • Guidance on Emergency Response to COVID-19 - (Web) - (PDF) - 3.5.2020
  • Guidance for Medicaid Pharmacies Regarding the Declared Disaster Emergency in the State of New York over COVID-19 - (Web) - (PDF) - Updated 4.6.2020
  • Guidance for Transportation Managers and Brokers - (Web) - (PDF) - 3.21.2020
  • Guidance for Facilitated Enrollment Agencies for the Aged, Blind and Disabled. - (Web) - (PDF) - 3.21.2020
  • Guidance for Nursing Home Transition and Diversion (NHTD) and Traumatic Brain Injury (TBI) 1915 (c) Medicaid Waiver Providers in Response to COVID-19 - (Web) - (PDF) - 3.20.2020
  • Guidance for Designated Children and Family Treatment and Support Services´ Providers - (Web) - (PDF) - 3.19.2020 Updated 6.10.2020
  • Guidance for the Authorization of Community-Based, Long-Term Services and Supports Covered by Medicaid in response to COVID-19 - (Web) - (PDF) - Updated 4.8.2020
  • Guidance issued by Centers for Medicare & Medicaid Services (CMS) to all Programs of All-Inclusive Care for the Elderly (PACE) Organizations (POs) in response to COVID-19 (PDF) - 3.17.2020
  • Immediate Temporary Suspension of Statewide Adult Day Health Care Program Services as a Response to COVID-19 - (PDF) - 3.17.2020
  • Guidance for Certified Home Health Agencies, Long Term Home Health Care Programs, Hospices, and Licensed Home Care Services Agencies Related to COVID-19 - (Web) - (PDF) - 3.14.2020
  • Guidance for Home and Community-Based Services (HCBS) Providers Serving Children/Youth Under the 1915(c) Children´s Waiver Related to COVID-19 - (Web) - (PDF) - 3.14.2020 Updated 6.10.2020
  • Guidance for Health Homes Serving Adults, Health Homes Serving Children/Youth, and Care Coordination Organization/Health Homes (CCO/HH) Related to COVID-19 - (Web) - (PDF) - 3.14.2020
  • Health Advisory: COVID-19 Cases in Nursing Homes and Adult Care Facilities - (PDF) - 3.13.2020
  • Medicaid Update Special Edition: New York State Medicaid Coverage and Reimbursement Policy for Services Related to COVID-19 - (Web) - (PDF) - (Redline PDF)- Issued 3.10.2020, Updated 3.27.2020
  • Webinar for NYS DOH Health Care Providers: Update on COVID-19 for NYS Healthcare Providers - 3.5.2020