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

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  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).