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Medicaid Managed Care

No premiums. No copays. Just quality health care.

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MetroPlusHealth Medicaid Managed Care is our plan for people eligible for Medicaid, a government assistance program. You may qualify for Medicaid if you have high medical bills, receive Supplemental Security Income (SSI), or meet certain income, resource, age or disability requirements.

MetroPlusHealth Medicaid Managed Care offers low- or no-cost health coverage to New Yorkers who live anywhere in New York City. You can choose your own primary care physician (PCP). When it comes to other doctors, you can pick from a comprehensive list of providers in all five boroughs.

Covered services range from emergency visits to prenatal care. Best of all, MetroPlusHealth Medicaid Managed Care comes with no monthly premiums or copays.

Member Rewards Program for Medicaid Members

Earn rewards for making healthy choices!

Plan features

  • 24-hour emergency hotline

  • Dental care

  • Family planning

  • Hospital care

  • Lab tests and x-rays

  • Live customer service representatives who speak your language

  • Personal Care / Home Attendant Services

  • Specialist Care

  • Regular check-ups and office visits with your own Primary Care Provider (PCP)

  • Transportation for eligible members*

  • Vision and hearing examinations

  • Well-baby and well-child care visits

  • Behavioral health and mental health services

Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency

Comprehensive updated guidance regarding use of telehealth (including telephonic services) and billing guidance and criteria following the end of the Coronavirus Disease 2019 Public Health Emergency, released by the New York State Department of Health.

Medicaid, PIC, HARP, CHP:

NON-EMERGENCY TRANSPORTATION BENEFIT:

Your non-emergency transportation benefit is provided by Medical Answering Services (MAS). Need to schedule a ride?

Call 844-666-6270 or Schedule Online!

Medicaid Managed Care Benefits

There is no copay for covered benefits!

No-Stress Transportation

Whether you have a medical appointment near your home or across town, MetroPlusHealth wants to ensure you get the care you need when you need it without the stress of getting there. We also want to ensure you arrive at your appointment timely without having to rely on family or friends for your transportation. So…MetroPlusHealth is happy to announce that effective immediately, Medical Answering Services, LLC (MAS) will be responsible for providing you with non-emergency medical transportation services for eligible Medicaid beneficiaries living in the five boroughs of New York City. We encourage our member to take advantage of this benefit in order to ensure that services are provided. If you need to schedule or inquire about receiving transportation benefits please contact MetroPlusHealth Customer Service Department at 1-800-303-9626 (TTY: 711) if you need assistance. Please also provide ample time for your appointment to be scheduled.

Please note in order to be eligible for Medicaid transportation benefits your provider must complete Form 2015 which is verification of Medicaid Transportation Abilities.

Mental Health and Substance Use Services for Children

Effective January 1, 2019, new mental health and substance use services are available with NYS Children’s Medicaid. These services give children/youth (under age 21) and their families the power to improve their health, well-being and quality of life, strengthening families and helping them make informed decisions about their care. Services are provided at home or in the community. Learn more on our Children and Family Support Services page here.

Enroll Anytime

Medicaid Managed Care has a year-round open enrollment period. Learn more about Medicaid and how to enroll with MetroPlusHealth below:

Benefits You Can Get From MetroPlus Health Plan or With Your Medicaid Card - Handbook Inserts

Member Notice – Family Planning
Effective: October 2024

Important Notice: Undocumented Non-Citizens Age 65 and Over

Undocumented non-citizens who are age 65 and over can now join MetroPlusHealth’s Medicaid Managed Care plan. Learn more below.

   

Dental Services – Medicaid, PIC, HARP

Starting January 31, 2024, MetroPlusHealth will be covering crowns and root canals in certain circumstances so that you can keep more of your natural teeth.

Mobile Crisis Telephonic Triage Response Service

Starting March 1, 2024, MetroPlusHealth will cover the Mobile Crisis Telephonic Triage and Response service for members under the age of 21. This service is already available to members 21 years of age and older.

Important Pharmacy News for our Medicaid, Partnership In Care, and Enhanced Members.

Rx Carveout

Beginning April 1, 2023, all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

Information about the transition of the pharmacy benefit from MetroPlusHealth to NYRx, the Medicaid Pharmacy Program can be found here.

General information about NYRx, the Medicaid Pharmacy Program can be found here along with information for Members and Providers.

 

Member and Provider FAQs - Pharmacy Benefit Carve-Out
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals
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I have been with them for many years and have only good things to say about MetroPlusHealth. They are always helpful, understanding, and working with me.

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IMPORTANT NOTICE FOR OUR MEDICAID MEMBERS AGED 18 YEARS AND OLDER

MetroPlusHeath is proud to offer benefits and services that help you live a healthy life. Starting July 1, 2022, you can join a no-cost Medically Tailored Meals program that provides healthy meals straight to your home.

Through this program, you and other members who qualify can get:

  • Help from a registered dietitian and nutritionist. This person is a food and nutrition expert and will help give guidance and support in choosing healthy foods.

Up to three meals per day delivered to your home for six months at a time. You may be able to continue receiving meals as long as you are eligible for this program. These meals are tailored for your specific health needs and can help you gain access to healthy, nutritious foods.

 

Ready to learn more—or to apply?

Call us at 1-855-809-4073 or visit us at our Virtual Office. Just click here to find a representative in your neighborhood who speaks your language and is ready to help. We can even enroll you over the phone. You can also contact us here. One of our representatives will reach out to you ASAP to review your plan options.

Important notice about your Medicaid managed care plan benefits.

Starting January 1, 2023, MetroPlusHealth will cover Gambling Disorder Treatment provided by Office of Addiction Services and Supports (OASAS) certified programs.

You can get Gambling Disorder Treatment:

  • face-to-face; or
  • through telehealth.

Learn more below, in the Plan Materials section.

Our Member Handbook explains the details of your MetroPlusHealth Medicaid coverage, including your benefits, the rules of the plan, and information about how to receive care.

Important Notice: Effective October 1, 2021, our members now access their behavioral health services through MetroPlusHealth. Learn more here.

If you would like a hard copy of this handbook, you can submit a request online here or call us at 1-800-303-9626 (TTY: 711). Please be sure to tell us which plan handbook – for example, Medicaid – you need.

Speak to MetroPlusHealth

Questions? Ready to sign-up?

Our Member Services team is always here to help. We are here Monday through Saturday from 8:00AM to 8:00PM. Just call 1.800.303.9626 (TTY:711).

Our 24/7 Customer Service Hotline will answer your call at other times and on holidays.

Medicare members can call us 24/7 at 1.866.986.0356 (TTY: 711).

If you are experiencing a mental health crisis, our Behavioral Health Crisis after hours partner — Vibrant Emotional Health — can be reached 24/7 at 1.866.728.1885 (SMS capable for the hearing impaired).

IMPORTANT NOTICE TO OUR MEDICAID MEMBERS

Announcing a New Foster Care Transition to Medicaid Managed Care- Special Population

Starting July 1, 2021, MetroPlusHealth will cover Article 29-I Voluntary Foster Care Agency (VFCA) Health Facility services for children and youths under age 21 in foster care and other special populations, as indicated.

Also starting July 1, 2021, some children and youth must join a Medicaid managed care plan, including:

  • children and youth placed in foster care in New York City, and
  • children and youth placed in foster care and a 29-I VFCA Health Facility

Some children and youth placed in foster care cannot join a Medicaid managed care plan. They will keep getting services through regular Medicaid.

Complaints and Appeals

We hope our health plan serves you well. But if you have a problem, you can talk with your PCP, or call or write our Member Services. Most problems can be solved right away. If you have a problem or dispute with your care or services, you can file a complaint with us. Problems that are not solved right away over the phone — and any complaint that comes in the mail — will be handled according to our complaint procedure described here.

Did you know?

If you are turning 65 within the next 3 months or you are 65 years of age or older, you may be entitled to additional medical benefits through the Medicare program. Learn more here. If you have questions, please call Customer Services team at 1-800-303-9626. If you have Medicaid, you MUST apply for Medicare as a condition of continuing eligibility.

You can apply for Medicare by calling the Social Security Administration at 1-800-772-1213 or by applying on-line at: https://www.ssa.gov/medicare/. You may be required to submit proof that you have applied for Medicare so please keep your award or denial letter from SSA or your on line receipt from SSA.

If you have more questions, please call our Customer Services team at 1-800-303-9626.

Important Update

Pharmacy Network Change

Starting January 1, 2022, Walgreens and Duane Reade will no longer be in the pharmacy network for members of these plans:

  • Medicaid Managed Care (including Partnership in Care and HARP Plans)
  • Child Health Plus
  • Exchange / MarketPlace Plans

Where can I find a list of participating network pharmacies?

Members can find a list of network pharmacies or use our online provider search tool.

What do I do if I get my medications from Walgreens or Duane Reade?

Members who have an ongoing prescription including medications, certain supplies such as pen needles, test strips, continuous glucose monitors, and blood glucose test strips at a Walgreens or Duane Reade should call their health care providers to get a new prescription to be sent to a different pharmacy.

Who can I call if I have questions?

If you have any questions, please call the Rx Customer Services Team at 1-(855) 656-0361 for Child Health Plus members or 1-(855) 383-9426 for Exchange Plan members.

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MetroPlusHealth Virtual Visit

Access to a doctor—whenever and wherever you need it!

MetroPlusHealth Virtual Visit is the fast, easy way for our members to see a provider for common physical, mental, emotional, and behavioral health issues that are not emergencies. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 – and in your language.

GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.

Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.

Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.

Know your rights and protections against surprise medical bills!

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

Are you receiving care at an NYC Health + Hospitals facility?

Manage Your Health Online With MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:

  • Message your primary care provider’s office
  • Request refills of your prescription drugs
  • Access your test results
  • Schedule appointments
Preventive Services Resources

Learn about all of the free preventive services for adults, women and children. Preventive care includes immunizations, physical exams, lab tests and prescriptions. If you have any questions, call one of our Member Services Representatives. We’re here to help.

Explore all MetroPlusHealth Plans

last updated: October 24, 2024

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