Jane Dotson
EmblemHealth is one of the largest non-profit health insurance companies in the United States, with over 3 million members in New York and the tristate area. They offer a range of insurance options, including individual and family plans, employer plans, and Medicare. EmblemHealth also provides Medicaid Managed Care, a state-sponsored plan that offers access to doctors within the EmblemHealth network with no monthly premium payment. Medicaid members can also access family planning services, dental care, nursing home services, and more.
| Characteristics | Values |
|---|---|
| Type | Medicaid Managed Care |
| Provider | EmblemHealth |
| Premium | No monthly premium payment |
| Pharmacy | Pharmacy copayments are required for some individuals |
| Eligibility | Low-income individuals, families, and children |
| Eligibility | Pregnant women |
| Eligibility | People with disabilities |
| Eligibility | Children under age 21 who are covered by Medicaid and have mental health or substance use needs |
| Eligibility | Individuals must reside in the Bronx, Kings, Nassau, New York, Queens, Richmond, Suffolk, or Westchester County |
| Dental Care | Covered |
| Vision Care | Covered |
| Nursing Home Care | Covered |
| Personal Care | Covered |
| Addiction Treatment | Covered |
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What You'll Learn
- Medicaid Managed Care members get access to doctors within the EmblemHealth network
- Medicaid covers family planning services, including dental care
- Medicaid and HARP members can access EmblemHealth's telehealth portal
- Medicaid Managed Care plan provides 12 months of continuous eligibility for children up to age 6
- EmblemHealth covers long-term nursing home placement
Medicaid Managed Care members get access to doctors within the EmblemHealth network
Medicaid Managed Care members can access EmblemHealth's large hospital and provider network. This includes doctors and other healthcare providers, such as ophthalmologists, optometrists, and dentists, with no monthly premium payment required. However, pharmacy copayments are required for some individuals. Members can use the Find a Doctor tool or the provider directory on the EmblemHealth website to locate participating doctors and other healthcare professionals.
Medicaid and HARP members aged 18-45 who are expecting or planning to start a family can access EmblemHealth's telehealth portal for information on childbirth education classes, breastfeeding support, nutrition, and child safety. EmblemHealth also offers Medicaid Managed Care members additional Special Services for Children at no extra cost. These services include screening, diagnosis, and treatment related to physical and behavioral health, as well as Children's Family Treatment and Support Services (CFTSS).
Medicaid Managed Care members have certain rights and responsibilities. They have the right to receive information about EmblemHealth's services, practitioners, and provider networks. Members can also request a list of physicians and other healthcare providers in the participating provider network and have the right to change their physician. Additionally, members are responsible for providing accurate and relevant information about their medical history and health to ensure appropriate treatment and care. They are also expected to treat EmblemHealth personnel and other healthcare providers with consideration and courtesy.
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Medicaid covers family planning services, including dental care
EmblemHealth is a health insurance company that offers Medicaid Managed Care plans. These plans provide members with access to a large hospital and provider network.
Medicaid is a federal program that provides health insurance coverage to individuals and families with low incomes and resources. Since 1972, states have been required to provide family planning services under their Medicaid programs. The Affordable Care Act has expanded the number of people who can benefit from these services by allowing states to offer them to individuals who would not otherwise be eligible for Medicaid.
Medicaid covers a range of family planning services, including prescription contraceptives, health education and promotion, and testing and treatment for sexually transmitted infections (STIs). Most states also provide coverage for preconception services such as screening for obesity, smoking, and mental illness. Additionally, Medicaid covers routine dental care, including routine exams, cleanings, fillings, and emergency treatment. For EmblemHealth members with Medicaid Managed Care, dental services are provided through Healthplex, which has a large network of dentists.
Medicaid also covers personal care services, such as the Consumer Directed Personal Assistance Program (CDPAP), which provides home care for individuals who need assistance with personal hygiene, dressing, feeding, meal preparation, and housekeeping. Other covered services include long-term placement in a nursing home, ophthalmic services, and in-home health emergency alert systems.
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Medicaid and HARP members can access EmblemHealth's telehealth portal
EmblemHealth is a health insurance company that provides members with the latest plan and health information. The company is dedicated to helping its members stay healthy, get well, and live better. They offer a range of state-sponsored programs, including Medicaid and the Health and Recovery Plan (HARP).
Medicaid members are entitled to a standard set of benefits and can directly access certain services without a referral. These services can be found in the Direct Access (Self-Referral) Services section of the Access to Care and Delivery System chapter. HARP, on the other hand, is designed to meet the unique needs of eligible members living with serious mental illness and/or substance use disorder.
During the COVID-19 State of Emergency, EmblemHealth waived the requirement for Medicare Advantage members to obtain a primary care physician referral to receive specialist services. They also introduced a Temporary Telehealth Policy to help navigate the new way of delivering patient care during the pandemic. EmblemHealth covers telehealth services if they are deemed medically necessary.
In addition to telehealth services, EmblemHealth offers a range of other benefits under Medicaid and HARP. For example, Medicaid members can receive dental care, eye care, and personal care services. They also cover long-term placement in a nursing home for members aged 21 and above. Eligible veterans, spouses of eligible veterans, and Gold Star parents of eligible veterans may choose to stay in a veterans' nursing home.
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Medicaid Managed Care plan provides 12 months of continuous eligibility for children up to age 6
EmblemHealth is a health insurance company that provides Medicaid-managed care plans. Medicaid is a health insurance program that provides coverage for individuals who meet certain income and eligibility requirements. Managed care is the predominant delivery system in Medicaid, with over 70% of beneficiaries receiving care through a managed care plan. EmblemHealth offers a range of Medicaid-managed care services, including dental care, personal care, and nursing home services.
One important feature of Medicaid is that it provides continuous eligibility for children, ensuring that they have access to consistent healthcare services. As of January 1, 2024, states are required to provide 12 months of continuous eligibility for children under the age of 19 enrolled in Medicaid and the Children's Health Insurance Program (CHIP). This means that children up to the age of 6 with a Medicaid Managed Care plan are eligible for continuous coverage for a full year, regardless of changes in their family's income or circumstances.
The continuous eligibility provision ensures that children have uninterrupted access to the healthcare services they need. This can include routine check-ups, immunizations, dental care, and treatment for illnesses or injuries. By providing 12 months of coverage, children can receive timely and consistent care, which can improve their overall health and well-being.
EmblemHealth's Medicaid Managed Care plan likely includes a range of benefits for children up to age 6, such as well-child visits, preventive care, and treatment for common childhood illnesses. The plan may also cover services like vision and dental care, which are essential for maintaining overall health. Additionally, EmblemHealth may offer access to a large network of providers, including paediatricians and specialists, to ensure that children receive the best possible care.
Overall, the Medicaid Managed Care plan's 12 months of continuous eligibility for children up to age 6 provides stability and peace of mind for families. It ensures that children have consistent access to the healthcare services they need to grow and thrive, regardless of changes in their family's circumstances. This comprehensive coverage plays a crucial role in supporting the health and development of young children.
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EmblemHealth covers long-term nursing home placement
EmblemHealth, through its companies Group Health Incorporated (GHI) and HIP Health Plan of New York (HIP), provides affordable, quality health care coverage and administrative services to nearly 3.3 million people. EmblemHealth covers long-term nursing home placement for members over 21 years of age. Eligible veterans, spouses of eligible veterans, and gold star parents of eligible veterans may choose to stay in a veterans' nursing home.
Covered nursing home services include speech-language pathology and other services. These services must be ordered by a physician and authorized by EmblemHealth. To have EmblemHealth pay for these services, members must be found financially eligible for long-term nursing home care by their County Department of Social Services. Members must select a nursing home that is part of EmblemHealth's network. However, if members prefer to live in a nursing home outside of the network, they may transfer to another plan that works with their chosen nursing home.
EmblemHealth also provides Medicaid Managed Care and Child Health Plus plans. Medicaid Managed Care members can access dental services through Healthplex, which has a large network of dentists, including a clinic operated by an academic dental center. Medicaid Managed Care and Child Health Plus members can call the customer service department for assistance. EmblemHealth also offers a telehealth portal for Medicaid and HARP members (ages 18-45) who are expecting or planning to start a family.
The Care Management program at EmblemHealth aims to coordinate optimal, cost-effective, and quality care for its members. This includes prior approval, concurrent management, discharge planning, and case management services. The Utilization and Care Management department assists clinicians in determining appropriate care and settings to maximize member clinical outcomes and benefit coverage. EmblemHealth has also introduced a Managed Long-Term Care (MLTC) program to assist frail, elderly, and disabled individuals in maintaining their independence at home. The MLTC program is available in all five boroughs of New York City and surrounding counties, providing personalized care plans and additional support services.
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Frequently asked questions
EmblemHealth is one of the largest non-profit health insurance companies in the United States. They provide health insurance to over 3 million members in New York and the tristate area. They offer individual and family plans, employer plans, and Medicare.
EmblemHealth's Medicaid Managed Care plan provides access to doctors within the EmblemHealth network for no monthly premium payment, although pharmacy copayments are required for some individuals. Medicaid Managed Care members can also receive covered dental services under their plan, such as routine exams, cleanings, fillings, and emergency treatment. Additionally, EmblemHealth covers long-term placement in nursing homes for members aged 21 and above.
To be eligible for EmblemHealth's Medicaid Managed Care plan, individuals must reside in specific counties, including the Bronx, Kings, Nassau, New York, Queens, and Suffolk. Additional eligibility factors include low-income individuals, families, and children, pregnant women, and people with disabilities.
You can contact EmblemHealth's Customer Service department at 855-283-2146. Their staff is available Monday through Friday, 8 am to 6 pm, excluding major holidays. You can also access their automated service 24 hours a day, seven days a week.
