Consumer Checklist

Asking the Right Questions About Medicaid Managed Care Options

If you are on Medicaid and live in a mandatory county, you must select a managed care health plan at time of enrollment or recertification starting October 1, 2011. Mandatory counties are listed on an attachment.  This does not apply to you if you are in the Medicaid Spend-down program or enrolled in the Long Term Home Health Care Program. If you are also on Medicare, it does not apply to you. All Health Plans are required to cover the same level of benefits you get in regular Medicaid.

Where can I get information about Health Plans?

  • In some counties you can call your local social services district
  • In counties that use an enrollment broker contact New York Medicaid CHOICE at 1-800-505-5678 to ask which Health Plan your medical providers work with. You will want to complete checklist of providers on back.
  • Get Regional Consumer Health Plan Guides from this website or my local department of social services. Guide includes plan websites and contact information.

What Health Plans can I choose?

  • There are different Medicaid health plans in the counties of New York State. Not all Plans are in each county.
  • The Regional Consumer Health Plan Guide lists the Health Plans available to you. It is based on the county where you live.
  • Decide if you want to be in the same plan as your children.

Who should I talk to?

  • Medical Care Providers like your primary care doctor, HIV Specialist, diabetes specialist, heart specialist or your mental health provider. You may also want to talk with your Case Manager, family member or other peers who have been in Health Plans.
  • Member Services people at the Plans are available to answer questions about enrollment and whether your providers are in the Plan´s network.

What questions should I ask a Health Plan?

  • Use the Consumer Checklist before you talk about choosing a plan.
  • Add questions that are important to you.
  • Ask questions about how the care you need will be provided.
  • Ask if you can keep your doctor.
  • Ask the plan if they have any special services to help you.
  • Note: Once you enroll, ask your Plan about New Member Orientation. Let them know about any special care needs you have or services you are receiving. Use the plan´s services to help you get the care and support you need.

How to use this checklist

Think about your health needs and what you need to take care of yourself and family. Which needs are most important to you? This check list will help you think about what is important to you when you choose a Plan. It will also help you ask the questions you need to have answered to make an informed choice and find the Plan that best meets your needs.

Questions to answer before you talk to a plan and make a choice. You will have a limited time to choose so having this information makes it easier.

  • What Plans are available in the County I live in?
  • Who are my Primary Care Provider (PCP) and HIV specialist? List Provider Name and facility.
  • Are there other Providers that I see? List name, specialty and facility.
  • What provider do I see most often? List Provider name and facility.
  • What provider(s) am I willing to change when I choose a plan? List name, speciality and facility.
  • Do I see a mental health provider? List Provider name and facility.

Questions to as a Health Plan*

  • Will I have to change providers if I choose this plan? Are the providers listed above in your network?
  • How are referrals to specialist handled? Do I need a referral to see my specialists?
  • Do you assist with transportation to medical appointments?
  • Do you cover dental services?

* Get name and contact information at the health plan in case you want to speak to them again.

Mandatory Medicaid Managed Care Counties (in Brown)

NYS map highlighting mandatory Medicaid Managed Care counties

Counties Using the New York Medicaid CHOICE Enrollment Broker - Phone: 1-800-505-5678

  • Albany
  • Allegany
  • Broome
  • Cayuga
  • Chemung
  • Chenango
  • Clinton
  • Columbia
  • Cortland
  • Dutchess
  • Erie
  • Essex
  • Franklin
  • Fulton
  • Genesee
  • Greene
  • Hamilton
  • Herkimer
  • Jefferson
  • Lewis
  • Livingston,
  • Madison
  • Monroe
  • Montgomery
  • Nassau
  • Niagara
  • Oneida
  • Onondaga
  • Ontario
  • Orange
  • Oswego
  • Otsego
  • Putnam
  • Rensselaer
  • Rockland
  • St. Lawrence
  • Saratoga
  • Schenectady
  • Schoharie
  • Schuyler
  • Steuben
  • Suffolk
  • Sullivan
  • Tioga
  • Ulster
  • Warren
  • Washington
  • Wayne
  • Westchester
  • Yates
  • NYC