NYS Contracted Health Plan Network Adequacy Standards
Medicaid Managed Care, HIV Special Needs Plan,
Health and Recovery Plan (HARP)
Network Adequacy contractual requirements for the Medicaid Managed Care, HIV Special Needs Plan, or Health and Recovery Plan (HARP) can be found in Section 21 of the Model Contract.
Guidelines for Managed Care Organization (MCO) Service Delivery Networks
New York State reviews the networks of all Medicaid Managed Care/HIV Special Needs Plan/Health and Recovery Plan contracted managed care organizations for availability, accessibility of services, and adequacy. Please see the below table.
| Health Plan | Offers an appropriate range of preventive, primary care, specialty services, and Long Term Services and Supports (LTSS) that is adequate for the anticipated number of enrollees for the services area. |
Maintains a network of providers that is sufficient in number, mix, and geographic distribution to meet the needs of the anticipated number of enrollees in the service area. |
|---|---|---|
| Affinity Health Plan | ☒ | ☒ |
| Amida Care | ☒ | ☒ |
| Blue Cross/Blue Shield of Western New York (HealthNow, Inc.) | ☒ | ☒ |
| Capital District Physicians’ Health Plan (CDPHP) | ☒ | ☒ |
| Crystal Run Health Plan | ☒ | ☒ |
| Emblem Health (Health Insurance Plan of Greater New York) | ☒ | ☒ |
| Excellus Health Plan | ☒ | ☒ |
| Fidelis Care (New York State Catholic Health Plan) | ☒ | ☒ |
| HealthFirst | ☒ | ☒ |
| Empire Blue Cross/Blue Shield (HealthPlus, LLC) | ☒ | ☒ |
| Independent Health | ☒ | ☒ |
| MetroPlus Health Plan | ☒ | ☒ |
| MVP Health Plan | ☒ | ☒ |
| Molina Healthcare | ☒ | ☒ |
| UnitedHealthcare | ☒ | ☒ |
| VNS Choice Health Plan | ☒ | ☒ |
| WellCare | ☒ | ☒ |
| YourCare | ☒ | ☒ |
To see if a specific provider participates with a specific managed care organization, please visit https://pndslookup.health.ny.gov/.
Last Updated: October 2018
