Information for Providers

Medicaid Update

The Medicaid Update is a monthly publication which highlights the most current policy and guidance changes within the New York State Medicaid program.

Providers who would like to recieve the Medicaid Update each month via email may sign up by emailing: medicaidupdate@health.ny.gov.

eMedNY

The eMedNY website is a 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.

NYS Local Departments
of Social Service

To find the contact information for a New York State Local Department of Social Service (LDSS) visit our LDSS Directory page at the link below.

LDSS Contact Directory.

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.

Frequesntly Asked Questions (FAQs) about NY Medicaid Benefits


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

The U.S. Department of Health & Human Services (HHS) has formally declared the U.S. to be in a public health emergency since early 2020 due to the COVID-19 pandemic. While the public health emergency is in place, New York State is allowed to keep people enrolled in Medicaid, Child Health Plus (CHP), and the Essential Plan (EP) without having them go through their annual renewal. However, when the public health emergency ends, people enrolled in these programs will once again have to take action to renew their coverage.

In an effort to minimize the number of New Yorkers at risk of losing their Medicaid, CHP or EP coverage, NY State 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.

COVID-19 Guidance for Medicaid Providers

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

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.

  • 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.

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).

Archive

Please see the New York State Medicaid Archive page to find information on past programs and guidance.

Contact Information and Additional Resources