New York State Public Managed Care Programs
Medicaid Managed Care
- NYS residents with full Medicaid eligibility.
- Most Medicaid covered adults, children, & pregnant women.
- Enrollment mandatory in 37 counties and NYC.
- Voluntary enrollment in some counties
- Some Medicaid covered populations exempt (can enroll voluntarily) or excluded (cannot enroll). Individuals with Medicare and permanent residents of nursing homes are excluded (cannot enroll).
For more information click here.
Family Health Plus
- Uninsured adults ages 19 to 64.
- Not eligible for Medicaid.
- Gross Family Income
-Young adults (age 19 up to age 21) residing with parents and parents with children under age 21 in their households: 150% FPL.
-Young adults (age 19 up to age 21) living alone and adults without children: 100% FPL.
- U.S. Citizen, National, Native American or an individual with satisfactory immigration status.
In order to receive coverage, eligible individuals must enroll in a health plan. For more information click here.
Family Health Plus Premium Assistance Program
- Adults ages 19 to 64.
- Not eligible for Medicaid.
- Gross Family Income and resource limits:
-Young adults (age 19 up to age 21) residing with parents and parents with children under age 21 in their households: 150% FPL.
-Young adults (age 19 up to age 21) living alone and adults without children: 100% FPL.
- U.S. Citizen, National, Native American or an individual with satisfactory immigration status.
In order to receive coverage, eligible individuals must enroll in an employer sponsored health insurance plan that is deemed by NYS to be qualified and cost effective. The FHPlus program will then pay for the individual’s share of the premium. For more information click here.
CHPlus
- Uninsured children one month up to age 19.
- Not eligible for Medicaid.
- Premium subsidized for incomes at 160% to below 400% FPL. Full premium available for incomes above 400% FPL. No premium below 160%.
- No citizenship requirements.
In order to receive coverage, eligible individuals must enroll in a health plan. For more information click here.
Managed Long Term Care
- Enrollment is voluntary.
- Eligible for nursing home care using the Semi-Annual Assessment of Members.
- Able to live safely in the community upon enrollment.
- In need of the long term care services of the plan for at least 120 days (nursing, therapy or aide services in the home; or adult day health care; or social day care if used as a substitute for personal care services).
- PACE: Adults 55 and older. Members must have Medicaid and/or Medicare and/or willingness to pay privately. Must disenroll from any facility or HCBS waiver program, Hospice, or any MCO before enrolling.
- Medicaid Advantage Plus (MAP): Adults 18 and older. Members must be dually-eligible for Medicaid and Medicare; must also be enrolled in a companion Medicare Advantage Plan.
- Partial Cap MLTC: Adults 18 and older (for most plans). Members must have Medicaid or willingness to pay privately (in some plans); can be enrolled in Medicare MCO concurrently but not Medicaid.
For more information click here.
Medicaid Advantage
- Enrollment is voluntary for eligible recipients.
- Eligibility criteria:
-Must have Medicare Part A and Part B coverage.
-Must have full Medicaid coverage.
-Must be 18 years of age or older.
-Must otherwise not be excluded from enrolling in Medicaid managed care.
- Must enroll in the same plan for both Medicare and Medicaid services.
For more information click here.
Healthy New York
- Small business owners providing health insurance to their employees and their families.
- Working individuals whose employers do not provide health insurance.
Individuals may participate if:
- they have been employed at some time during the past year or your spouse has been employed in the past year or you are a sole proprietor.
- they have been without health insurance for 12 months or have lost coverage for certain reasons.
- are ineligible for Medicare or employer coverage.
- total household income is within the annual limits.
In order to receive coverage, eligible individuals must enroll in a health plan. For more information click here.