Medicaid Managed Care (2024)

Your non-emergency transportation benefit is provided by Medical Answering Services (MAS). Need to schedule a ride?

Call 844-666-6270 or Schedule Online!

There is no copay for covered benefits!

No-Stress Transportation

Whether you have a medical appointment near your home or across town, MetroPlusHealthwants to ensure you get the care you need when you need it without the stress of getting there. We also want to ensure you arrive at your appointment timely without having to rely on family or friends for your transportation. So…MetroPlusHealth is happy to announce that effective immediately, Medical Answering Services, LLC (MAS) will be responsible for providing you with non-emergency medical transportation services for eligible Medicaid beneficiaries living in the five boroughs of New York City. We encourage our member to take advantage of this benefit in order to ensure that services are provided. If you need to schedule or inquire about receiving transportation benefits please contact MetroPlusHealthCustomer Service Department at 1-800-303-9626 (TTY: 711) if you need assistance. Please also provide ample time for your appointment to be scheduled.

Please note in order to be eligible for Medicaid transportation benefits your provider must complete Form 2015 which is verification of Medicaid Transportation Abilities.

Mental Health and Substance Use Services for Children

Effective January 1, 2019, new mental health and substance use services are available with NYS Children’s Medicaid. These services give children/youth (under age 21) and their families the power to improve their health, well-being and quality of life, strengthening families and helping them make informed decisions about their care. Services are provided at home or in the community. Learn more on our Children and Family Support Services pagehere.

Enroll Anytime

Medicaid Managed Care has a year-round open enrollment period. Learn more about Medicaid and how to enroll with MetroPlusHealth below:

• NY State of Health, The Official Health Plan Marketplace, online athttps://nystateofhealth.ny.govor by phone at 1-855-355-5777
• Navigators and Certified Application Counselors
• Medicaid Helpline 1-800-541-2831
• Local Departments of Social Services

IMPORTANT NOTICE FOR OUR MEDICAID MEMBERS AGED 18 YEARS AND OLDER

MetroPlusHeath is proud to offer benefits and services that help you live a healthy life. Starting July 1, 2022, you can join a no-cost Medically Tailored Meals program that provides healthy meals straight to your home.

Through this program, you and other members who qualify can get:

• Help from a registered dietitian and nutritionist. This person is a food and nutrition expert and will help give guidance and support in choosing healthy foods.

Up to three meals per day delivered to your home for six months at a time. You may be able to continue receiving meals as long as you are eligible for this program. These meals are tailored for your specific health needs and can help you gain access to healthy, nutritious foods.

Ready to learn more—or to apply?

Call us at1-855-809-4073or visit us at our Virtual Office. Just clickhereto find a representative in your neighborhood who speaks your language and is ready to help. We can even enroll you over the phone. You can also contact ushere. One of our representatives will reach out to you ASAP to review your plan options.

Important notice about your Medicaid managed care plan benefits.

StartingJanuary 1, 2023, MetroPlusHealth will cover Gambling Disorder Treatment provided by Office of Addiction Services and Supports (OASAS) certified programs.

You can get Gambling Disorder Treatment:

• face-to-face; or
• through telehealth.

Learn more below, in the Plan Materials section.

Our Member Handbook explains the details of your MetroPlusHealth Medicaid coverage, including your benefits, the rules of the plan, and information about how to receive care.

Important Notice:Effective October 1, 2021, our members now access their behavioral health services through MetroPlusHealth. Learn morehere.

If you would like a hard copy of this handbook, you can submit a request onlinehereor call us at 1-800-303-9626 (TTY: 711). Please be sure to tell us which plan handbook – for example, Medicaid – you need.

Our Member Services team is always here to help. We are here Monday through Saturday from 8:00AM to 8:00PM. Just call1.800.303.9626(TTY:711).

Our 24/7 Customer Service Hotline will answer your call at other times and on holidays.

Medicare members can call us 24/7 at1.866.986.0356(TTY: 711).

If you are experiencing a mental health crisis, our Behavioral Health Crisis after hours partner — Vibrant Emotional Health — can be reached 24/7 at 1.866.728.1885 (SMS capable for the hearing impaired).

StartingJuly 1, 2021, MetroPlusHealth will cover Article 29-I Voluntary Foster Care Agency (VFCA) Health Facility services for children and youths under age 21 in foster careand other special populations, as indicated.

Also startingJuly 1, 2021, some children and youth must join a Medicaid managed care plan, including:

• children and youth placed in foster care in New York City, and
• children and youth placed in foster care and a 29-I VFCA Health Facility

Some children and youth placed in foster care cannot join a Medicaid managed care plan. They will keep getting services through regular Medicaid.

If you are turning 65 within the next 3 months or you are 65 years of age or older, you may be entitled to additional medical benefits through the Medicare program. Learn more here. If you have questions, please call Customer Services team at 1-800-303-9626.If you have Medicaid, you MUST apply for Medicare as a condition of continuing eligibility.

You can apply for Medicare by calling the Social Security Administration at1-800-772-1213or by applying on-line at:https://www.ssa.gov/medicare/. You may be required to submit proof that you have applied for Medicare so please keep your award or denial letter from SSA or your on line receipt from SSA.

If you have more questions, please call our Customer Services team at1-800-303-9626.

Starting January 1, 2022, Walgreens and Duane Reade will no longer be in the pharmacy network for members of these plans:

• Medicaid Managed Care(including Partnership in Care and HARP Plans)
• Child Health Plus
• Exchange / MarketPlace Plans

Where can I find a list of participating network pharmacies?

Members can find a list of network pharmacies or use our online provider search tool.

What do I do if I get my medications from Walgreens or Duane Reade?

Members who have an ongoing prescription including medications, certain supplies such as pen needles, test strips, continuous glucose monitors, and blood glucose test strips at a Walgreens or Duane Reade should call their health care providers to get a new prescription to be sent to a different pharmacy.

Who can I call if I have questions?

If you have any questions, please call the Rx Customer Services Teamat1-(855) 656-0361 for Child Health Plus members or 1-(855) 383-9426 for Exchange Plan members.

*Find A Dentist: Participating dental providers for all our health plans, excluding MetroPlusHealth Gold and GoldCare

Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.

Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.

Manage Your Health Online With MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:

• Message your primary care provider’s office
• Request refills of your prescription drugs
• Access your test results
• Schedule appointments

Explore all MetroPlusHealth Plans