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Information for Providers

Medicaid Prescriber Education Program (MPEP)

The Medicaid Prescriber Education Program (MPEP) is a partnership between the New York State Department of Health and the University at Buffalo School of Pharmacy and Pharmaceutical Sciences. MPEP offers evidence-based, online continuing education on current topics in pharmacotherapy.
View the catalog of free accredited continuing education activities at https://nypep.nysdoh.suny.edu/.

Healthcare Worker Bonus (HWB) Program

The Healthcare Worker Bonus (HWB) Program allows for the payment of bonuses to "recruit, retain, and reward health care and mental hygiene workers" meeting specified eligibility requirements.

Learn more about the program at the link above or submit a claim on behalf of a qualified employee within the HWB Program Portal.

Important Changes to Medicaid Dental Services

Beginning January 31, 2024 NYS Medicaid Dental Service benefits are changing. More information at the links below.

November 8, 2023

Attention Members: Policy Notice (PDF)
Attention Providers: Benefit Criteria Guidance (PDF) and Clinical Criteria Guidance (PDF)

Unwinding from the COVID-19 Public Health Emergency: A Communications Tool Kit to Keep New Yorkers Covered

Important changes are coming. New federal rules will require New York State to begin redetermining eligibility for public program enrollees in the Spring of 2023. Enrollees in Medicaid, Child Health Plus (CHP) and the Essential Plan (EP) have not had to renew their health insurance since early 2020 due to the COVID-19 public health emergency (PHE) continuous coverage requirements for these public programs, which were adopted by the Families First Coronavirus Response Act in March 2020. However, the December 2022 Consolidated Appropriations Act included new rules ending the continuous coverage requirements starting Spring 2023.

Beginning in Spring 2023, renewal notices will be sent to enrollees in these programs based on their enrollment end dates. Renewal notices will include the deadline to take action to renew their insurance or risk having a gap in coverage. Deadlines will be based on the enrollees' enrollment end dates and will range from June 30, 2023 through May 31, 2024.

In an effort to minimize the number of New Yorkers at risk of losing their Medicaid, CHP or EP coverage, the New York State Department of Health is working with partners, local districts and other stakeholders to inform New Yorkers about renewing their coverage and exploring other available health insurance options if they no longer qualify for Medicaid, CHP or EP.

PHE Communications Toolkit

Educational Fact Sheets for Medicaid Stakeholders

These fact sheets provide important information for all Medicaid stakeholders on a variety of health topics. A printable PDF link is available for each fact sheet topic in a number of languages.

Educational Fact Sheets

Frequently Asked Questions (FAQs) about NY Medicaid Benefits

FAQs about NY Medicaid Benefits

New York State Medicaid Program Areas

For more information about a specific NYS Medicaid program area visit the program page by selecting from the links below.

Doula Services Benefit
The New York State enacted 2023-24 Executive Budget includes expanded Medicaid coverage of preventative care, including coverage and higher reimbursement for doulas. Learn more about the NYS Medicaid Doula Services Benefit.
Family Planning Benefit Program (FPBP)
The FPBP is a public health insurance program for New Yorkers who need family planning services, but may not be able to afford them.
Integrated Care for Dual Eligible New Yorkers (DUALS)
Dual-eligible beneficiaries (Medicare "dual-eligibles" or "duals") refers to those who qualify for both Medicare and Medicaid benefits.
Medicaid Finance and Rate Setting
The Division of Finance and Rate Setting (DFRS) is within the Office of Health Insurance Programs and responsible for all functions related to Medicaid rate setting, including Medicaid managed care premium development. This division has full oversight of the Medicaid budget and is the liaison with the Division of the Budget and managing the Medicaid Global Spending Cap.
Medicaid Health Homes
A ´Health Home´ is not a physical place; it is a group of health care and service providers working together to make sure you get the care and services you need to stay healthy. Once you are enrolled in a Health Home, you will have a care manager that works with you to develop a care plan that maps out the services you need, to put you on the road to better health.
Medicaid Managed Care
Managed Care is a term used to describe a health insurance plan or health care system that coordinates your health care. 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.
Medicaid Pharmacy Program
The New York State Medicaid Pharmacy program covers medically necessary FDA approved prescription and non-prescription drugs for Medicaid fee-for-service and Medicaid Managed Care enrollees.
Medicaid and Medicare Part D
Medicare Part D is a prescription drug benefit available to everyone with Medicare.
NYS Medicaid Telehealth Information
Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance. Medicaid covered services provided via telehealth include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a Medicaid member.

Provider-Specific Programs, Policy, and Committee Groups

NY Medicaid EHR Incentive Program Through the NY Medicaid EHR Incentive Program, eligible professionals (EPs) and eligible hospitals (EHs) in New York who adopted, implemented, or upgraded certified EHR technology (CEHRT), and subsequently became meaningful users of CEHRT, could qualify for and receive financial incentives.
eMedNY
The eMedNY website is for provider resource with helpful manuals and reference material related to offerings of the electronic Medicaid system of New York State. The site is updated regularly to meet the ever-growing needs of the State provider community.
Prescription Drug Prices in NY
The NYS Board of Pharmacy publishes an annual list of the 150 most frequently prescribed drugs, in the most common quantities and the NYS Department of Health collects retail price information on these drugs from pharmacies that participate in the Medicaid program and from pharmacies that submit their retail price information directly to the Department. This site allows search of specific drugs from the most frequently prescribed drug list.
Medicaid Administrative Law Judges (ALJ) Decisions
This web page contains decisions by the New York State Department of Health (DOH) Administrative Law Judges (ALJ) in cases seeking recovery of overpayments from providers under the Medical Assistance Program (Medicaid).
Supplemental Payment to Ambulance Providers
The 2015-16 enacted New York State budget requires the Department of Health to make annual supplemental payments on a quarterly basis to ambulance providers who received a reimbursement for emergency transportation from the Medicaid Program during each quarter of each State Fiscal Year (SFY).
Medicaid Disability Manual
The Medicaid Disability Manual is the official policy guide for disability determinations for the Medicaid program in New York State.
Traumatic Brain Injury Program Manual
Long Term Home Health Care Program Manual
A reference guide for LDSS staff and Long Term Home Health Care Program (LTHHCP) providers.
HIPAA Information Center
Information related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

COVID-19 Guidance for Medicaid Providers

Visit the COVID-19 Guidance for Medicaid Providers web page for all COVID-19 related policy and billing guidance.

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Information for Providers

Medicaid Prescriber Education Program (MPEP)

Healthcare Worker Bonus (HWB) Program

Important Changes to Medicaid Dental Services

Unwinding from the COVID-19 Public Health Emergency: A Communications Tool Kit to Keep New Yorkers Covered

Educational Fact Sheets for Medicaid Stakeholders

Frequently Asked Questions (FAQs) about NY Medicaid Benefits

New York State Medicaid Program Areas

Provider-Specific Programs, Policy, and Committee Groups

COVID-19 Guidance for Medicaid Providers

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Information for Providers

Medicaid Prescriber Education Program (MPEP)

Healthcare Worker Bonus (HWB) Program

Important Changes to Medicaid Dental Services

Unwinding from the COVID-19 Public Health Emergency: A Communications Tool Kit to Keep New Yorkers Covered

Educational Fact Sheets for Medicaid Stakeholders

Frequently Asked Questions (FAQs) about NY Medicaid Benefits

New York State Medicaid Program Areas

Provider-Specific Programs, Policy, and Committee Groups

COVID-19 Guidance for Medicaid Providers

Archive

Contact Information and Additional Resources

Department of Health

General Information

COVID-19 Topics

Events

Current Issues/Info

Help

Language Assistance

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