New York State-Sponsored Programs for Individuals and Families
Medicaid, HARP, and Child Health Plus
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Find out if you qualify for low- or no-cost state-sponsored programs for individuals, families, and children. To enroll you must live in the eligible EmblemHealth service area: the five boroughs of New York City, Long Island, or Westchester County.
Don’t qualify for Medicaid? Find out if you’re eligible for a $0 premium Essential Plan.
Medicaid Managed Care |
Health and Recovery Plan (HARP) |
Child Health Plus (CHPlus) |
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EmblemHealth Enhanced Care delivers $0 premium health, vision, and dental coverage to eligible adults and children, plus $0 copays. Monthly Premium: Eligibility Age: |
EmblemHealth Enhanced Care Plus provides the same Medicaid benefits plus help with physical, behavioral, and non-Medicaid needs. Monthly Premium: Eligibility Age: |
Help your child stay healthy with low or no monthly costs. With Child Health Plus, there is never a copay. Monthly Premium: Eligibility Age: |
| Eligibility Requirementsinfo | ||
| Must meet Medicaid Managed Care income and eligibility requirementsMust meet Medicaid Managed Care and HARP income and eligibility requirementsFor children who are not eligible for Medicaid | ||
| Summary of Benefitsinfo | ||
| View detailsView detailsView details | ||
| Member Handbookinfo | ||
| View detailsView detailsn/a | ||
| Deductibleinfo | ||
| $0$0$0 | ||
| Maximum Out-of-Pocket (MOOP)info | ||
| $0$0$0 | ||
| Networkinfo | ||
| Enhanced Care PrimeEnhanced Care PrimePrime | ||
| Referralsinfo | ||
| No referrals required for specialist visitsNo referrals required for specialist visitsNo referrals required for specialist visits | ||
| Preventive Careinfo | ||
| Covered in fullCovered in fullCovered in full | ||
| Primary Care Provider (PCP) Visitinfo | ||
| $0 copay$0 copay$0 copay | ||
| Specialist Visitinfo | ||
| $0 copay$0 copay$0 copay | ||
| Outpatient Mental Health Visitinfo | ||
| $0 copay$0 copay$0 copay | ||
| Maternity Careinfo | ||
| $0 copay$0 copay$0 copay | ||
| Doula Servicesinfo | ||
| $0 copay$0 copayNot covered | ||
| Telemedicineinfo | ||
| $0 copay$0 copayNot covered | ||
| Urgent Care Visitinfo | ||
| $0 copay$0 copay$0 copay | ||
| Emergency Roominfo | ||
| $0 copay$0 copay$0 copay | ||
| Hospital Admissioninfo | ||
| $0 copay$0 copay$0 copay | ||
| Vision Careinfo | ||
| $0 copay$0 copay$0 copay | ||
| Dental Careinfo | ||
| $0 copay$0 copay$0 copay | ||
| Voluntary Foster Care Agency (VFCA) Servicesinfo | ||
| Coveredn/aCovered | ||
| Health Home Care Management Programinfo | ||
| View detailsView detailsNot covered | ||
| Durable Medical Equipment (DME) info | ||
| $0 copay$0 copay$0 copay | ||
| Prescription Drugs**info | ||
| $1 copay, generic drugs $3 copay, brand-name drugs $0.50 copay, nonprescription drugs $1 copay, generic drugs $3 copay, brand-name drugs $0.50 copay, nonprescription drugs $0 copay |
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Helpful Resources
Our plans offer access to top health care professionals and conveniently located pharmacies.
***AdvantageCare Physicians (ACPNY) is part of EmblemHealth.
The EmblemHealth Difference
Your health and well-being depends on more than just going to the doctor. That’s why we offer you additional wellness benefits to help keep you feeling your best.
†Free, with no obligation to enroll.
Frequently Asked Questions
Get the answers you need to make the most of your coverage.
Eligibility is based on income, family size, where you live, and other factors. EmblemHealth can help you learn if you’re eligible and help enroll you in a plan if you are. Please contact us at 866-230-1071 (TTY: 711) to see if you qualify.
New York State will let you know if you are eligible to join a Health and Recovery Plan (HARP). To learn more, see our HARP brochure.
Yes, Medicaid and HARP are available to legally-residing immigrants. During your enrollment process, you will need to provide documentation to support your legally-residing status. Children under the age of 19 may be eligible for CHPlus regardless of immigration status.
Not necessarily. Because eligibility for the Medicaid and Child Health Plus (CHPlus) programs is based on more than just family size and income, it is possible that members in the same family will be eligible for different programs.
For example, in a family with three children, it is possible that the youngest child will be eligible for Medicaid and the other children will be eligible for CHPlus. This will be because of differences in the age, immigration/citizenship status, or other eligibility requirements of different family members.
Members must renew their coverage every year. Visit our renewing coverage page for helpful resources, including a renewal checklist and short video on how to renew.
If you need assistance, we’re here to help. Call us at 888-432-8026 (TTY: 711) from 8 a.m. to 6 p.m., Monday through Friday. Prefer in-person support? Stop by or schedule an appointment at an EmblemHealth Sales Office or Neighborhood Care location near you.
Medicaid, HARP, and CHPlus provide coverage for preventive care, mental health and substance use disorder services, lab services, emergency room visits, hospital stays, rehabilitative and habilitative services, prescription drugs, and more as required by the Affordable Care Act (ACA). Coverage for vision and dental care is also included. Learn more about What Medicaid Covers.
Children under age 21 who have mental health or substance use needs can get additional Special Services for Children at no extra cost. These services are provided at home or in the community.
EmblemHealth also covers Article 29-I Voluntary Foster Care Agency (VFCA) Health Facilities services for children and youth under age 21. The 29-I VFCA Health Facilities work with families to promote well-being and positive outcomes for children in their care. The 29-I VFCA Health Facilities use trauma-informed practices to meet the unique needs of each child.
The duration of postpartum health coverage for Medicaid, HARP, and Child Health Plus (CHPlus) is a full year following pregnancy, regardless of your immigration status or how your pregnancy ended.
EmblemHealth’s network is designed to offer access to top health care professionals where you live and work. Medicaid, HARP, and CHPlus offer in-network coverage only. Members who receive out-of-network services are responsible for the full cost of such care, except in the case of a medical emergency.
