Information for Health Plans

NYS Department of Health
Medicaid Update

The Medicaid Update is a monthly publication which highlights the most current policy and guidance changes within the New York State Medicaid program.

Providers who would like to recieve the Medicaid Update each month via email may sign up by emailing: medicaidupdate@health.ny.gov.

Medicaid Finance
and Rate Setting

The Medicaid Finance and Rate Setting page provides regularly updated information on New York State Medicaid program rate and fee structures. The Division of Finance and Rate Setting (DFRS) is within the Office of Health Insurance Programs and responsible for all functions related to Medicaid rate setting, including Medicaid managed care premium development.

New York State Medicaid
Pharmacy Program

The New York State Medicaid Pharmacy Program covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid Fee-for-Service (FFS) and Medicaid Managed Care enrollees.

Unwinding from the COVID-19 Public Health Emergency: A Communications Tool Kit to Keep New Yorkers Covered

Important changes are coming. New federal rules will require New York State to begin redetermining eligibility for public program enrollees in the Spring of 2023. Enrollees in Medicaid, Child Health Plus (CHP) and the Essential Plan (EP) have not had to renew their health insurance since early 2020 due to the COVID-19 public health emergency (PHE) continuous coverage requirements for these public programs, which were adopted by the Families First Coronavirus Response Act in March 2020. However, the December 2022 Consolidated Appropriations Act included new rules ending the continuous coverage requirements starting Spring 2023.

Beginning in Spring 2023, renewal notices will be sent to enrollees in these programs based on their enrollment end dates. Renewal notices will include the deadline to take action to renew their insurance or risk having a gap in coverage. Deadlines will be based on the enrollees’ enrollment end dates and will range from June 30, 2023 through May 31, 2024.

In an effort to minimize the number of New Yorkers at risk of losing their Medicaid, CHP or EP coverage, the New York State Department of Health is working with partners, local districts and other stakeholders to inform New Yorkers about renewing their coverage and exploring other available health insurance options if they no longer qualify for Medicaid, CHP or EP.

Educational Fact Sheets for Medicaid Stakeholders

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


New York State Medicaid Program Areas

For more information about a specific NY Medicaid program visit the program page by selecting from the links below.

  • eMedNY

    • The eMedNY website is for provider resource with helpful manuals and reference material related to offerings of the electronic Medicaid system of New York State. The site is updated regularly to meet the ever-growing needs of the State provider community.

  • 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 for Dual Eligible New Yorkers (DUALS)

    • Dual-eligible beneficiaries (Medicare "dual-eligibles" or "duals") refers to those who qualify for both Medicare and Medicaid benefits.

  • 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

    • The New York State Medicaid Pharmacy program covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid fee-for-service and Medicaid Managed Care enrollees.
    • Prescription Drug Prices
      The NYS Board of Pharmacy publishes an annual list of the 150 most frequently prescribed drugs, in the most common quantities and the NYS Department of Health collects retail price information on these drugs from pharmacies that participate in the Medicaid program and from pharmacies that submit their retail price information directly to the Department. This site allows search of specific drugs from the most frequently prescribed drug list.

  • NY Medicaid EHR Incentive Program

    • Through the NY Medicaid EHR Incentive Program, eligible professionals (EPs) and eligible hospitals (EHs) in New York who adopted, implemented, or upgraded certified EHR technology (CEHRT), and subsequently became meaningful users of CEHRT, could qualify for and receive financial incentives.

  • Medicaid and Medicare Part D

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

New York State Medicaid Program-Specific Manuals

  • Long Term Home Health Care Program Manual

    • A reference guide for LDSS staff and Long Term Home Health Care Program (LTHHCP) providers.

  • Medicaid Disability Manual

    • The Medicaid Disability Manual is the official policy guide for disability determinations for the Medicaid program in New York State.

  • Traumatic Brain Injury Program Manual

    • The Traumatic Brain Injury Program Manual is dedicated to all participants of the past, present and future, and to those individuals who have assisted people with brain injuries to be in control of their lives and to live as independently as possible in the community.

Archive

Please see the New York State Medicaid Archive page to find information on past programs and guidance.

Contact Information and Additional Resources