Frequently Asked Questions

  • FAQs also available in Portable Document Format (PDF, 64KB)

1. What is changing for Behavioral Health services for adults in New York State?

  • Medicaid is changing to cover more mental health and substance use disorders (drug and alcohol use) services for adults.
  • Medicaid Managed Care plans already provide physical health care services and behavioral health care to their enrollees. Now, Medicaid Managed Care plans will also include more mental health and substance use disorder services called Behavioral Health services.

2. Will people enrolled in Medicaid Managed Care plans have to change their doctor or other providers?

  • People who stay with the Medicaid Managed Care plan they have now will not need to change doctors or other providers, unless they want to.
  • Some people may want to use this opportunity to compare their current plan with other plans that are available. This way you can make sure that you are getting all of the services that are right for you. You may want to use care managers, family, and/or friends to help you decide what plan is right for you.
  • If you are happy with your current provider and they are part of the new plan´s network, you will just need to let that provider know you changed managed care plans.
  • If you are happy with your current provider but they are not part of the new plan´s network, you will need to choose another plan. There are protections in place so you can continue to receive services from your current provider as you make the transition to a new provider.
  • This option is time limited and dependent on your current provider´s willingness to work with the new plan during transition.

3. Once these services are covered by Medicaid Managed Care, will people be able to keep taking the same medication?

  • The medication that people are currently taking should not change due to the behavioral health changes in Medicaid Managed Care. Please keep in mind that Medicaid Managed Care plans may change their formulary and prior authorization requirements from time to time. For an active prescription, people should go back to the doctor or prescriber who ordered it to get a renewal.

4. What can people do if their mental health or substance use service provider is not part of their Plan´s network?

  • They can find out if their current provider is in another Plan´s network, or if the provider is planning to be part of their Plan´s network. People may be able to switch to a new plan to continue seeing the same providers. People can talk with their providers and their Medicaid Managed Care plan to help decide what might be the best option.

5. What is a Health and Recovery Plan (HARP)?

  • A Health and Recovery Plan (HARP) is a Medicaid Managed Care plan for people eligible for Medicaid Managed Care, age 21 or older, with serious mental health and/or substance use disorders. Like other Medicaid Managed Care plans, HARPs have providers in their networks that have a lot of experience treating persons who need behavioral health care.
  • HARPs have care managers for their members. Care managers help all of a person´s providers work together on the goals important to the person. HARP members will have all the benefits they had in their Medicaid Managed Care plan, and may also be eligible for new benefits called Behavioral Health Home and Community Based Services (BH HCBS).

6. What managed care services will people enrolled in Medicaid Managed Care get if they don´t qualify for HARP enrollment?

  • People will continue to get the same physical and behavioral health services they get that are covered by Medicaid. These services will be coordinated by a Medicaid Managed Care plan. For these people, the Medicaid Managed Care plan will provide expanded behavioral health services, such as PROS, ACT or opioid treatment.

7. When will people be notified about the changes for adults, and if it impacts them?

  • In New York City, changes began October 1, 2015 with Behavioral Health Home and Community-Based Services (BH HCBS) becoming available January 1, 2016. Medicaid Managed Care plan enrollees who are eligible to join a HARP have already received notices. Outside of New York City, notices started going out to eligible enrollees in May. The changes will begin July 1, 2016. BH HCBS will become available October 1, 2016.
  • People can contact New York Medicaid Choice with any questions at 844-427-7999.

8. Who is going to help enrollees make decisions about what services they need?

  • People enrolled in a Medicaid Managed Care plan can get help making decisions about their care from the same people who help them now, like their families, therapists, and friends. In a HARP, they will also have a Health Home Care Manager to work with them to develop a Plan of Care. Care planning can include others who are part of their support network. The enrollee´s ideas and what they want will be very important in making the Plan of Care.

9. Will Medicaid pay for travel to BH HCBS or things like job interviews?

  • Transportation to BH HCBS for adults is covered by Non-Medical Transportation as long as it is in the person´s Plan of Care. Non-Medical Transportation can also be for non-routine trips that help people reach goals in their Plan of Care. For example, a person who has a goal of finding a job may use Non-Medical Transportation to go to a job interview.

10. Where can people find a list of the Medicaid Managed Care plans?

  • The directory of Medicaid Managed Care plans is on the NYS Department of Health website, under Managed Care Plans.
  • People´s providers can also tell them what Medicaid Managed Care plan networks they are part of.