Information for Providers
Medicaid Prescriber Education Program (MPEP)
The Medicaid Prescriber Education Program (MPEP) is a partnership between the New York State Department of Health and the University at Buffalo School of Pharmacy and Pharmaceutical Sciences. MPEP offers evidence-based, online continuing education on current topics in pharmacotherapy.
View the catalog of free accredited continuing education activities at https://nypep.nysdoh.suny.edu/.
Medicaid Update
The Medicaid Update is a monthly publication which highlights the most current policy and guidance changes within the New York State Medicaid program.
Providers who would like to recieve the Medicaid Update each month via email may sign up by emailing: medicaidupdate@health.ny.gov.
Important Changes to Medicaid Dental Services
Beginning January 31, 2024 NYS Medicaid Dental Service benefits have changed. Vist the Medicaid Dental Benefits page for more information.
New NYS Medicaid Dental Polices Webinar - 1/2/2024
Recording - Slide Deck
Resources and Fact Sheets for Medicaid Stakeholders
Fact Sheets
Fact sheets provide important information for all Medicaid stakeholders on a variety of coverage and health related topics. Some fact sheets are designed specifically for consumers and available in a number of languages.
COVID-19 Guidance
The COVID-19 Guidance for Medicaid Providers web page includes all COVID-19 related policy and billing guidance.
Frequently Asked Questions (FAQs) about NY Medicaid Benefits
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.
- Adverse Childhood Experiences (ACEs)
New York State Medicaid encourages providers to screen for Adverse Childhood Experiences (ACEs) in patients. ACEs are categorized as abuse, neglect, and household challenges experienced during childhood. Screening for ACEs with evidence-based tools helps clinical teams move toward prevention and also identify individuals at high risk who may benefit from additional assessment and interventions.
- Career Pathways Training (CPT) Program
The Career Pathways Training (CPT) Program is an education and training program that was authorized under New York’s 1115 Demonstration Waiver, and is designed to create a reliable workforce pipeline to address workforce shortages by funding education and training for health, behavioral health and social care workers throughout New York State.
- Dental Benefits
New York State Medicaid offers an extensive dental plan for Medicaid members, through the New York State Fee-for-Service program or through a Medicaid Managed Care plan.
- Doula Services Benefit
The New York State enacted 2023-24 Executive Budget includes expanded Medicaid coverage of preventative care, including coverage and higher reimbursement for doulas. Learn more about the NYS Medicaid Doula Services Benefit.
- 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.
- NYS Medicaid Telehealth Information
Telehealth is defined as the use of electronic information and communication technologies to deliver health care to patients at a distance. Medicaid covered services provided via telehealth include assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a Medicaid member.
- Social Care Networks (SCNs)
This program establishes regionally based Social Care Networks (SCNs) to increase and strengthen the delivery of social care services to Medicaid members including physical and behavioral health services, food and housing security support services, and transportation services.
Provider-Specific Programs, Policy, and Committee Groups
- New York State Medicaid State-Directed Quality Incentive Program to Reduce Low-Risk Cesarean Delivery Rates
- 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).
Archive
Please see the New York State Medicaid Archive page to find information on past programs and guidance.
Contact Information and Additional Resources
Follow NYS Medicaid