Medicaid
What is Medicaid?
Medicaid is a low cost or no cost medical insurance that covers services that are medically necessary to keep an individual healthy
Medicaid and FBPB
What is the Difference Between Medicare and Medicaid?
Both programs provide health insurance to consumers; however, they both have different eligibility criteria, such as age and income. There are also differences in out of pocket costs, such as premiums and co-payments. Also, some people may qualify for both programs.
Medicare FAQ
Does CHP have co-payments?
There are no co-payments, co-insurance, or deductibles for services under Child Health Plus
CHPlus FAQ
What is the Essential Plan?
EP is a health insurance option for New Yorkers offered through the NY State of Health Marketplace. It costs much less than other health plans and it offers the same 'essential' benefits to keep one healthy. Individuals with income between 138% and 200% of the federal poverty level (FPL) may be eligible for EP, as well as those referred to as “Aliessa” consumers – individuals who are lawfully present in the United States but do not qualify for Medicaid due to their immigration status
Essential plan FAQ
What are the percentages for the Metal Levels?
60% (Bronze)
70% (Silver)
80% (Gold)
90% (Platinum)
Individual Plan Selection Enrollment and Changes
I have health insurance other than Medicaid. Which card should I use to access services?
First check coverage in eMedNY to see what kind of other health insurance is held by the consumer. If it is TPHI, such as employer-sponsored insurance or Medicare: When you have other insurance, also called Third Party Health Insurance, in addition to Medicaid, Medicaid will not cover the services that are already covered by the TPHI. The TPHI will be the “first payer” while Medicaid is the “payer of last resort”. You should show all of your cards and the provider will bill the proper plan first.
Medicaid and FBPB
What does my Medicare card look like?
Your Medicare card is red, white, and blue. Your Medicare card shows that you have Medicare health insurance. It shows whether you have Part A (Hospital Insurance), Part B (Medical Insurance) or both, and it shows the date your coverage starts.
Medicare FAQ
Are there any children in New York that are not eligible to participate in CHP?
Children may not participate in Child Health Plus if they are enrolled or have access to coverage through a State health benefits program (NYSHIP)
CHPlus FAQ
What are the services covered under the Essential plan?
Essential plan FAQ
What is the Manual ID Proofing process?
Check eMedNY to determine if the Account Holder ever had a Medicaid, FHP, or FPBP Case at the LDSS/HRA. Refer to Using eMedNY Job Aid.
If the Account Holder had a Medicaid, FHP, or FPBP Case at the LDSS/HRA, Identity Proofing can be overridden by following the “eMedNY Verification Process” instructions outlined in the Identity Proofing – Alternative Process Job Aid.
Once the Manual ID Proofing is complete, click End Session or Dashboard to return to the Overview tab. If the Application Status reads “IN PROGRESS”, no further action is necessary.
Click Continue Application to complete the application.
Processing in Individual marketplace
Does Medicaid cover transportation services?
Transportation is covered for those who are eligible and enrolled in Medicaid. It is provided to get consumers to and from Medicaid covered service appointments. Medicaid pays for rides at the least costly, most medically appropriate level. Consumers must use their CBIC card for transportation services.
Medicaid and FBPB
What is a Medicare Advantage Plan?
Also known as a Medicare Advantage Plan, Part C is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. If you're enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and are not paid for under Original Medicare (Part A & Part B). Most Medicare Advantage Plans offer prescription drug coverage.
Medicare FAQ
Is there an age limit for CHP?
Yes. Children turning 19 are covered until the end of the month in which they turn 19. The Marketplace will send a notice about 45 days before the child turns 19 telling them to go to the Marketplace to update their account if they need to continue to receive coverage.
Child Health Plus FAQ
Can EP consumer apply for retro Medicaid?
Consumers who are eligible for the Essential Plan are eligible to apply for Retroactive Medicaid Coverage.
Essential plan FAQ
What screen in Emedny can you see if a consumer has Medicare?
TPHI Screens
Using Emedny
What is the list of carved out services?
Emergency and/or Non-Emergency Transportation except for Fidelis in Rockland County. Refer to the Transportation Information section.
School Based Health Center Services
Assisted Living Program
School Supportive Health Services Ages 5-21
Medicaid and FBPB
Can you list the 4 Medicare Savings Plans?
QDWI: Medicaid pays for the Medicare Part A premium only. Medical services, Medicare coinsurance or deductibles are not covered by Medicaid. Consumers with questions about how much income they are permitted, should be referred to their LDSS/HRA
Medicare FAQ
How much would a consumer CHP Premium would be for a family of 5, 3 children living in Broome County and wants to have Fidelis Care and is making about 15000 a month for income?
Full Pay CHP -$191.82 per child
Child Health plus FAQ
If i am an Essential plan consumer and it is outside of open enrollment am i allowed to change my plan?
Yes. You can change your plan at any time throughout the year.
Essential plan FAQ
What are the 4 different types of Authorized reps that may be granted?
One-Time Authorization
Provider
24-hour authorization
Permanent authorization
Caller Verification Authentication and Authorized Representative
If a consumer gets a settlement who handles settlements for Medicaid consumers?
DOH contracts with a third-party, Health Management Systems (HMS), to handle Medicaid casualty recoveries for NYSOH Medicaid recipients who receive settlements from lawsuits.
Medicaid and FBPB
If an elderly consumer needs help to supplement their out-of-pocket part D prescription costs which program would you recommend for them?
EPIC- Elderly Pharmaceutical Insurance Coverage
Medicare FAQ
How many days does consumer have for there managed care lock-in period for CHP?
There is no managed care lock-in period for CHP, a child may disenroll or change plans at any time. Plan changes made on or before the 15th of the month will become effective at the beginning of the next month. Changes made after the 15th may result in a gap in coverage with coverage starting the following month with the new plan.
Child Health Plus FAQ
What are the prescription costs for the essential plans?
Prescription Drugs
150-200% FPL
139-150% FPL
100-138% FPL
Below 100% FPL
Tier 1 (Generic)
$6
$1
$1
$0
Tier 2 (Formulary Brand)
$15
$3
$3
$0
Tier 3 (Non-Formulary Brand)
$30
$3
$3
$0
NOTE: The amounts above are retail copays for a 90 day supply. Mail order prescription copays are 2.5 times the retail copays.
Essential plan FAQ
What Type/Subtype would you use for a consumer calling in regarding documentation that was requested?
Application Processing/Application Status
Consumer calls requesting the status of their application (account), including eligibility determination, plan information and/or documentation requests.
Siebel Navigation and Types and Sub-Types