New York State Medicaid Pharmacy Benefits have recently changed. Find out how these changes may effect you at: NYRx Information for Medicaid Members.

Member Benefits

NY Medicaid benefits cover regular exams, immunizations, doctor and clinic visits, relevant medical supplies and equipment, lab tests and x-rays, vision, dental, nursing home services, hospital stays, emergencies, and prescriptions.

Have questions about Medicaid member benefits? Visit the Frequently Asked Questions (FAQs) page for answers to the most common member questions including topics such as how to obtain payment records.

Educational Fact Sheets for Members

These fact sheets provide important information for members on a variety of health topics. A printable PDF link is available for each fact sheet topic in a number of languages.

IRS 1095 Form

Members who wish to request a copy of their 1095-B Form can do so in the following ways:

• By Phone: (800) 541-2831
• By e-mail: 1095B@health.ny.gov
• By mail: NY State of Health, P.O. Box 11774, Albany, NY 12211

More information about the 1095-B Form can be found here.

Additional Programs

Information on additional programs can be found in the section below. Application and eligibility requirements for each program vary. Please see the individual program web pages for additional information and eligibility criteria.

•   Child Health Plus

New York State has a health insurance plan for kids, called Child Health Plus. Depending on your family's income, your child may be eligible to join either Children's Medicaid or Child Health Plus. Both Children's Medicaid and Child Health Plus are available through dozens of providers throughout the state.

•   Consumer Directed Personal Assistance Services (CDPAS)

•   Dental Benefits

New York State Medicaid offers an extensive dental plan for Medicaid members, through the New York State Fee-for-Service program or through a Medicaid Managed Care plan.

•   Doula Services Benefit

The New York State enacted 2023-24 Executive Budget includes expanded Medicaid coverage of preventative care, including coverage and higher reimbursement for doulas. Learn more about the NYS Medicaid Doula Services Benefit.

•   Elderly Pharmaceutical Insurance Coverage (EPIC) Program

The EPIC program is a New York State program for seniors administered by the Department of Health. It helps more than 325,000 income-eligible seniors aged 65 and older to supplement their out-of-pocket Medicare Part D drug plan costs.

•   Family Planning Benefit Program (FPBP)

The FPBP is a public health insurance program for New Yorkers who need family planning services, but may not be able to afford them.

•   Integrated Care Plans for Dual Eligible New Yorkers

Dual Eligible refers to those who qualify for both Medicare and Medicaid benefits. An Integrated Care Plan is one that provides you with both your Medicaid and Medicare services from the same health plan.

•   Long Term Care

• Consumer Guide to Community-Based Care
• Partnership for Long Term Care Program

•  Medicaid Cancer Treatment Program (MCTP)

The MCTP is a Medicaid program for eligible persons who are found to be in need of treatment for breast, cervical, colorectal or prostate cancer (and in some cases, pre-cancerous conditions of these cancers)

•  Medicaid Health Homes

A 'Health Home' is not a physical place; it is a group of health care and service providers working together to make sure you get the care and services you need to stay healthy. Once you are enrolled in a Health Home, you will have a care manager that works with you to develop a care plan that maps out the services you need, to put you on the road to better health.

•  Medicaid Managed Care

Managed Care is a term used to describe a health insurance plan or health care system that coordinates your health care. In general, when you enroll in a managed care plan, you select a regular doctor, called a primary care practitioner (PCP), who will be responsible for coordinating your health care.

•  Medicaid Pharmacy Program (NYRx)

The New York State Medicaid Pharmacy program (NYRx) covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid fee-for-service and Medicaid Managed Care enrollees.

•  Medicare

Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig's disease).

•  Medicaid and Medicare Part D

Medicare Part D is a prescription drug benefit available to everyone with Medicare.

•  Medicaid Transportation

The Medicaid Transportation program ensures Medicaid members can get to and from their medical appointments at no cost to them. The program covers non-emergency transportation, such as pre-scheduled trips to primary care and the dentist, for Medicaid members enrolled in fee-for-service and mainstream managed care.

•  Medicare Savings Program (MSP)

The MSP is a Medicaid-administered program that can assist people with limited income in paying for their Medicare premiums. Depending on your income, the MSP may also pay for other cost-sharing expenses.

•  NYS Medicaid Telehealth Information

Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance. Medicaid covers telehealth services for members including education, assessment, diagnosis, consultation, care management and/or self-management, and treatment.

•  New York State Smokers Quitline

Smoking is an addiction. Get Support. Don't give up.

•  Care at Home: A Handbook for Parents

(PDF currently under revision)