Information for Consumers/Medicaid Recipients

Changes to Medicaid Managed Care and Behavioral Health

Medicaid is changing the way people with mental health and substance use disorders (drug and substance use) get what they need to live, go to school, work and be part of the community.

Expanding Behavioral Health as part of Medicaid Managed Care

  • Mental health and substance use services are sometimes called "behavioral health"services
  • Medicaid Managed Care already provides physical health care and some behavioral health care services for enrolled in a Medicaid Managed Care plan
  • Now, Medicaid Managed Care will provide expanded mental health and substance use services

What do these changes mean?

  • Both behavioral health care and physical health care will be managed by Medicaid Managed Care plans
  • Medicaid Managed Care will focus on behavioral health care to help people with behavioral health needs reach their health and recovery goals
  • There will be more behavioral health services in New York´s Medicaid Managed Care plans that Medicaid eligible consumers who qualify can get in the community
  • Physicians and other service providers will work together to help people meet their own health and wellness goals

Who are these changes for?

  • These services are available only for consumers enrolled in a Medicaid Managed Care plan who are age 21 or over

These changes are not for consumers who:

  • Have both Medicaid and Medicare
  • Live in a nursing home
  • Are in a Managed Long Term Care Plan
  • Are under age 21
  • Receive services from the Office for
    People with Developmental Disabilities
    (OPWDD)

Health and Recovery Plans (HARPs)

A new kind of Medicaid Managed Care plan, called a Health and Recovery Plan (HARP), will provide more services for people with serious mental health and substance use disorders. HARPs will also provide all the same services covered by Medicaid Managed Care plans.

How do HARPs help their enrollees?

  • HARPs help enrollees get the services and help they need to live, go to school, work and be part of their community
  • HARPs have additional services called Home and Community Based Services (HCBS) to help enrollees find housing, live independently, return to school and graduate, find a job, manage stress, and get help from peers
  • HARPs provide additional coordination of services to help enrollees better manage the care they get

How do consumers join a HARP?

  • Eligible consumers will be offered the opportunity to join a HARP
  • Consumers who have used certain kinds of Medicaid mental health and substance use services in the past may be eligible to join a HARP
  • HARP eligible consumers will get a letter telling them that they are eligible and how to enroll

Behavioral Health Home and Community Based Services (BH HCBS)

  • BH HCBS are available for consumers who qualify for these services and who are enrolled in a HARP or a Special Needs Plan
  • BH HCBS are extra benefits and supports that can help consumers meet their recovery goals
  • BH HARP enrollees will have a Health Home Care Manager who will work with them to set up a care plan that may include these HCBS
  • HCBS are extra benefits and supports that can help consumers meet their recovery goals
  • HARP enrollees will have a Health Home Care Manager who will work with them to set up a care plan that may include these HCBS

When do these changes happen?

  • For Medicaid eligible people who live in New York City: Medicaid Managed Care plans began coverage of expanded behavioral health services in October 2015. Behavioral Health Home and Community Based Services became available in January 2016 to eligible people in HARPs or HIV SNPs.
  • For Medicaid eligible people who live outside of New York City: Medicaid Managed Care plans began coverage of the expanded behavioral health services in July 2016. Behavioral Health Home and Community Based Services will become available in October 2016 to eligible people in HARPs.

Frequently Asked Questions

A list of frequently asked questions on the changes to Medicaid and behavioral health can be found below:

Public Forums

The NYS Department of Health (DOH), NYS Office of Mental Health (OMH), NYS Office of Alcoholism and Substance Abuse Services (OASAS), and the New York City Department of Health and Mental Hygiene conducted a series of public forums to provide important updates on New York City´s transition to managed behavioral healthcare for adults and how this will impact the services people receive. A separate series of public forums were held in June 2016 with updates on the transition to managed behavioral healthcare for adults who live outside of New York City.

The presentation from the forums can be viewed below: