Effective April 1, 2023, Medicaid Managed Care (MMC) members, including children/youth placed in foster care, had their pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy Program. However, physician-administered drugs, durable medical equipment, prosthetics, orthotics, and supplies are still covered by EmblemHealth when billed as a medical or institutional claim (refer to the NYRx, Medical Supply Codes Billable by a Pharmacy manual for procedure codes).
The pharmacy benefit requirements for children/youth placed in foster care include, but are not limited to:
- Rapid replacement of medically necessary prescriptions.
- Transitional fills for children/youth newly placed in foster care.
In addition, upon placement into foster care, a child/youth is required to have an initial medical assessment within the first 30 days of the child/youth’s placement. The child/youth may use any primary care provider (PCP) or qualified practitioner in the EmblemHealth network for the purposes of this initial medical assessment. For ongoing primary care visits, if there is a discrepancy with the assigned PCP on the MMC member ID card, the child/youth should not be turned away. Instead, please immediately call EmblemHealth at 855-283-2146 to rectify this matter.
For more information, visit the State-Sponsored Programs provider hub.
JP 63744 11/2023
