Managed Care is a term that is used to describe a health insurance plan or health care system that coordinates the provision, quality and cost of care for its enrolled members. 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. Your PCP will refer you to specialists or other health care providers or procedures as necessary. It is usually required that you select health care providers from the managed care plan's network of professionals and hospitals. There are many different types of publically funded managed care programs in New York State serving residents in all age groups and various income levels.
Managed care plans pay the health care providers directly, so enrollees do not have to pay out-of-pocket for covered services or submit claim forms for care received from the plan's network of doctors. However, managed care plans can require co-pays paid directly to the provider at the time of service.
There are many different types of managed care plans. Most managed care plans certified by the New York State Department of Health offer health education classes or other programs to help enrollees stay healthy. Depending on the type of managed care plan you join, there may be additional services, such as transportation, available to you.
Medicaid Managed Care Pharmacy Benefit Information Center
Medicaid Managed Care
Medicaid Managed Care offers many New Yorkers a chance to choose a Medicaid health plan. Managed Care plans focus on preventive health care and provide enrollees with a medical home for themselves and their families. Use this web site to find out more about Medicaid managed care where you live.
Medicaid Managed Care Program Information
Information on the administration of the New York State Medicaid Managed Care Program is also available on this web site, including:
- Medicaid Encounter Data System (MEDS) III Data Dictionary (PDF, 3.7MB)
- Change Log (PDF, 172KB)
- Provider Network Data Dictionary – Version 7.0 (PDF, 3.0MB)
- Change Log (PDF, 179KB)
- MRT 1458: Medicaid Managed Care Supplemental Information and Updates
- Questions & Answers on the Elimination of Direct Marketing Related to Contract Provisions (Section 11, Appendices D & P) (PDF, 327KB)
- Medicaid Prenatal Care Standards
- Quality Strategy For the New York State Medicaid Managed Care Program, 2014 (PDF, 1.2MB)
- New York´s Operational Protocol for the Partnership Plan
- Managed Care Model Contracts
- Medicaid Managed Care for People with HIV and AIDS
- New York State Medicaid "Serious Adverse Event Reimbursement" (also known as New York State Medicaid "Never Events")
NYS Model Member Handbooks - October 2015
- Medicaid Managed Care (PDF, 707KB)
- Health and Recovery Plan (HARP) (PDF, 575Kb)
- HIV Special Needs Plan (PDF, 419KB)