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Enhanced (HARP) Plan

MetroPlusHealth Enhanced is a Health and Recovery Plan (HARP) qualified by New York State and has specialized expertise, tools and protocols that are not part of most medical plans.

URGENT MESSAGE FOR OUR MEMBERS AND THEIR PAID CAREGIVERS: ACT NOW.

Make sure your caregiver continues to get paid for your Consumer Directed Personal Assistance Program (CDPAP) services! The Department of Health will be partnering ONLY with Public Partnerships LLC (PPL) as the Statewide Fiscal Intermediary (SFI) for CDPAP. Your personal assistant (caregiver) will not get paid to take care of you unless you and your caregiver register with PPL by March 28, 2025.
Learn more and register before March 28 for continued payment through CDPAP here in English or here en Español.

Member Rewards Program for Enhanced (HARP) Plan Members

MetroPlusHealth Enhanced (HARP) is a plan that manages the physical health, mental health, and substance use services in an integrated way for adults requiring specialized protocols and expertise not found within most medical plans. This plan does not require you to change your current health care providers.

Earn rewards for making healthy choices!

Who is eligible?

Adult Medicaid and HIV Special Needs Plan (SNP) enrollees who are 21 or older with serious mental health conditions (mental illness and/or substance use disorders) are eligible to receive covered benefits.

Eligible individuals will be identified by the State if they are qualified to enroll giving them the opportunity to join a MetroPlusHealth Enhanced plan.

People who are eligible will get a letter in the mail informing of their eligibility and giving them the opportunity to opt out.

HARP enrollees will receive access to Medicaid, behavioral health, and an additional package of Home and Community Based Services (HCBS).

We use Health Homes to coordinate services for our members. If you choose to join a Health Home, MetroPlus can help you enroll in a Health Home that will assign you a personal Health Home Care Manager. Your Health Home Care Manager can help you make appointments, help you get social services, and keep track of your progress.

Your Health Home is responsible for giving you an assessment to see what Behavioral Health Home and Community Based Services you may need. Using the assessment, you and your Health Home Care Manager will work together to make a Plan of Care that is designed especially for you.

 

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).

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.

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

Your Member Handbook has been changed to include additional services

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

Member Notice – Family Planning
Effective: October 2024

   

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.

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.

 

CORE Member Brochure

Free or Low-Cost Preventive Health Care Services

Preventive Health Care Guidelines

At MetroPlusHealth, we always want you to be at your best. That’s why we encourage you and your family to take advantage of preventive care services available to you at low or no cost. We’ve listed dozens of FREE preventive services here for adults, women and children that just may help you be your healthiest yet.

Free or Low-Cost Preventive Health Care Services

Plan Benefits

In addition to managing all of your current Medicaid and Behavioral Health and CORE Services, the Enhanced (HARP) also covers Home and Community Based Services (BH HCBS). BH HCBS provide opportunities for Medicaid recipients with behavioral health conditions to receive specialized support services in their home or community.

Health Home Care Managers help you make appointments with your providers, stay on top of your medications and coordinate care across all of your treating clinicians. They also assess need for Behavioral Health Home and Community Based Services (BH HCBS). Working with your Health Home care managers, you will be given the opportunity to complete an assessment to determine which Home and Community Based services you are eligible to receive.

List of covered BH HCBS services:

  • Rehabilitation: Rehabilitation services are designed to restore an individual’s functional level to the highest degree possible and to facilitate integration into the community.
  • Crisis Intervention Benefit Transition: Effective February 1, 2022, BH HCBS Short-term and Intensive Crisis Respite services transitioned to Crisis Intervention Benefit Crisis Residence services, available to all Adult Medicaid Managed Care members

Effective February 1, 2022, BH HCBS services covered in Enhanced (HARP) include:

  • Habilitation: Habilitation services, which are typically provided on an individual basis, are designed to assist members in improving skills such as communications, activities of daily living, socialization, and use of community resources.
  • Education Support Services
  • Pre-vocational services that prepare individuals for employment.
  • Transitional employment services are available to strengthen an individual’s work record and work skills.
  • Intensive Supported Employment
  • Ongoing Supported Employment
  • Non-Medical Transportation: Non-Medical Transportation services are offered to members to access transportation to destinations that are related to achieving recovery such as a job interview, a college fair, a wellness seminar, or other relevant activities.
  • Peer Supports: Peer Support services are delivered by peers with a recovery focus and promote skills for coping with one’s behavioral health condition(s).
  • Educational Support Services: Educational Support Services are designed to assist individuals who want to start or return to school or formal training with a goal of achieving skills necessary to obtain employment. MetroPlusHealth’s Enhanced (HARP) is designed to provide person-centered recovery services that emphasizes and supports an individual’s potential for rehabilitation by maximizing quality of life and reducing symptoms of behavioral health conditions. Through empowerment, choice, treatment and education MetroPlusHealth’s Enhanced (HARP) promotes recovery, health and well-being.
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals

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.

Members and providers accessing MetroPlusHealth's online resource library
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.

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: April 18, 2025

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