New York State-Sponsored Programs for Individuals and Families
Medicaid, HARP, and Child Health Plus
Compare Plans
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 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:
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EmblemHealth Enhanced Care Plus provides the same Medicaid benefits plus help with physical, behavioral, and non-Medicaid needs. Monthly Premium: Eligibility Age:
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Help your child stay healthy with low or no monthly costs. With Child Health Plus, there is never a copay. Monthly Premium: Eligibility Age:
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| Eligibility Requirements Eligibility is based on income, family size, where you live, and other factors. Your age and immigration status may affect your eligibility. This information is for educational purposes only and eligibility must be confirmed by the NY State of Health or your local Department of Social Services/Human Resources Administration. | ||
| Must meet Medicaid Managed Care income and eligibility requirements | Must meet Medicaid Managed Care and HARP income and eligibility requirements | For children who are not eligible for Medicaid |
| Summary of Benefits The Summary of Benefits document shows you what your plan covers. | ||
| View details | View details | View details |
| Member Handbook Your member handbook is your guide to the full range of health care services available to you. | ||
| View details | View details | n/a |
| Deductible The amount you pay before your plan starts to pay. | ||
| $0 | $0 | $0 |
| Maximum Out-of-Pocket (MOOP) The most you will pay for covered health care services from in-network doctors in any year. | ||
| $0 | $0 | $0 |
| Network Health care professionals and facilities (doctors, hospitals, labs, etc.) that contract with EmblemHealth. They provide covered products and services to members. Members are responsible for the total cost of nonemergency care they receive outside their plan’s network. | ||
| Enhanced Care Prime | Enhanced Care Prime | Prime |
| Referrals A recommendation by a physician that a member receive care from a specialty physician or facility. | ||
| No referrals required for specialist visits | No referrals required for specialist visits | No referrals required for specialist visits |
| Preventive Care <a href="/content/emblemhealth/en_us/home/live-well/prevention.html"><b>Preventive care</b></a> is routine care to keep you well. This includes an annual physical, hearing exams, Pap smears, mammograms, immunizations, etc. | ||
| Covered in full | Covered in full | Covered in full |
| Primary Care Provider (PCP) Visit A visit with your Primary Care Provider (PCP) who knows your health history and recommends preventive care. | ||
| $0 copay | $0 copay | $0 copay |
| Specialist Visit This is a visit to a doctor who treats a specific concern or condition. You do not need a referral from your regular doctor to see a specialist. | ||
| $0 copay | $0 copay | $0 copay |
| Outpatient Mental Health Visit A visit to a mental health professional who offers diagnosis and treatment of mental health concerns or illnesses. | ||
| $0 copay | $0 copay | $0 copay |
| Maternity Care Maternity care includes prenatal care, childbirth classes, maternal care services, hospital delivery, and newborn nursery care. View your Summary of Benefits for more information. | ||
| $0 copay | $0 copay | $0 copay |
| Doula Services View the <a href="/content/emblemhealth/en_us/home/plans/state-sponsored-programs/medicaid-harp-chplus.html#does-medicaid-and-harp-cover-doula-services? ">FAQ</a> below for more information. | ||
| $0 copay | $0 copay | Not covered |
| Telehealth Virtual delivery of health care services by a participating provider who offers it, including assessment, diagnosis, and treatment. | ||
| $0 copay | $0 copay | $0 copay |
| Urgent Care Visit Care at a facility that handles nonemergency medical issues like minor cuts or strains, colds, or flu when your primary care provider (PCP) isn’t available. | ||
| $0 copay | $0 copay | $0 copay |
| Emergency Room Emergency care services are procedures, treatments, or services needed to evaluate or stabilize an emergency. | ||
| $0 copay | $0 copay | $0 copay |
| Hospital Admission Care in a hospital when a patient is admitted for inpatient care. | ||
| $0 copay | $0 copay | $0 copay |
| Vision Care Includes refractive eye exams, eyeglasses, and contact lens. | ||
| $0 copay | $0 copay | $0 copay |
| Dental Care Includes preventive, routine, and major dental care. | ||
| $0 copay | $0 copay | $0 copay |
| Voluntary Foster Care Agency (VFCA) Services The <a href="/content/emblemhealth/en_us/home/plans/state-sponsored-programs/medicaid-harp-chplus/vfca-services.html">29-I VFCA Health Facilities</a> work with families to promote well-being and positive outcomes for children under age 21 in their care. | ||
| Covered | n/a | Covered |
| Health Home Care Management Program A care management program available to HARP members, as well as children and adults with Medicaid who have chronic conditions. | ||
| View details | View details | Not covered |
| Durable Medical Equipment (DME) Equipment and supplies prescribed by your doctor such as crutches, orthotic devices, and wheelchairs. | ||
| $0 copay | $0 copay | $0 copay |
| Prescription Drugs** Prescription drug cost sharing by tier. Prescription and nonprescription medications must be authorized by a professional licensed to write prescriptions. | ||
| $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 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.
