Medicaid Family Planning Services

In the past, most people used Fee for Service Medicaid, which means that Medicaid paid separately for each service from a doctor, hospital, or specialist.

Now most Medicaid beneficiaries are required to join a Medicaid Managed Care plan. Medicaid Managed Care provides all the health care for individual Medicaid recipient through a Primary Care Provider (PCP) and support from a Managed Care Organization (MCO).

• What are the benefits of Managed Care?
• What programs are available through Managed Care?
• What do I need when I visit the doctor, hospital, or other health care provider?
• What about Family Planning Services?
• Whom do I contact for more information or if I have complaints?

• You have a regular doctor, your Primary Care Provider, who coordinates all your health care.
• There is a focus on prevention, including regular check-ups.
• There is no limit on the number of visits you or your children can have with your doctor.
• There are no co-pays.
• You can reach your health plan 24 hours a day, 7 days a week.
• There is improved access to clinics, laboratories, specialists and hospitals.
• Lower long-term costs
• Support from Managed Care Organization (MCO) Member Services

Disease management available through Managed Care includes:

• Asthma programs
• Immunization outreach
• Diabetes programs
• Cardiac programs
• Mental health programs
• Inpatient alcohol and substance abuse programs

Prevention programs include:

• Nutrition
• Hearing
• Vision
• Smoke cessation
• Weight reduction programs

Participants must show Benefit card and MCO card at all doctor and clinic visits. Referrals to specialists are generated by the Primary Care Physician, must be with an in-plan provider, and must be approved by the MCO before the visit.

Family Planning Services can be provided by any Medicaid provider. Family Planning Services do not require a referral from the Primary Care Physician and do not require authorization from the MCO. There are no fees or penalties in the case of Family Planning Services.

If you need information or have complaints contact your Managed Care Organization (MCO) first. If this does not resolve the issue, contact your local Department of Social Services office or the New York State Department of Health Complaint Line at 1-800-206-8125.