Medicaid Managed Care
Announcements & plan documents
What are you looking for?
Plan Materials
Your Member Handbook tells you about your covered benefits and services as defined by federal and New York State Medicaid laws and regulations. Learn about:
- limitations
- eligibility
- network providers
- how to access health care services
- your rights and responsibilities.
Handbook Inserts
Member Notice
Effective date: June 1, 2025
Member Notice
Effective date: April 1, 2025
Member Notice – Family Planning
Effective: October 2024
Undocumented non-citizens who are age 65 and over can now join MetroPlusHealth’s Medicaid Managed Care plan. Learn more below.
Benefits
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.
Member Notice
Effective date: July 1, 2024
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.
Member Notice – Family Planning
Effective: October 2024
Forms
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.
Find a doctor or specialist in your area today
Important Notices
Earn rewards for healthy habits!
$5,000 in built-in wellness extras, including:
- 26 dietitian visits/year (worth $2,600)
- 10 acupuncture sessions/year (worth $1,000)
- $1,400/year in gym reimbursements
- $300/year toward wellness apps
Covered benefits:
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
Resources to Help You Manage Your Plan
New to MetroPlusHealth?
As a new member, we recommend seeing your Primary Care Provider (PCP) within your first 90 days.
This quick visit helps you:
- Get important health checks like blood work and screenings
- Stay up-to-date on your immunizations
- Talk about preventive care like colon cancer tests and screenings
- Access education and counseling to better manage asthma, diabetes, high blood pressure, and more.
Telehealth Options Available from MetroPlusHealth
You can now connect with providers by phone or video. The New York State Department of Health has updated guidelines for telehealth services following the COVID-19 emergency. These convenient options make it easier to get the care you need—when you need it.
Need help scheduling? We’re here for you! Call us anytime at 800.303.9626
Contact us
Need a ride to your appointment?
For non-emergency medical transportation, MetroPlusHealth Medicaid Managed Care members are advised to call Medical Answering Services:
For more information about how to access your transportation services, call MAS at 844.666.6270, or visit their website at medanswering.com.
If you have an emergency and need an ambulance, you must call 911.
Medicaid Managed Care Benefits
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.
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.
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.