In 2013, children/youth in direct placement foster care in counties outside of New York City were mandatorily enrolled in Medicaid Managed Care (MMC). Effective July 1, 2021, children/youth in direct placement foster care in New York City, and children/youth placed in foster care in the care of Voluntary Foster Care Agencies (VFCAs) statewide were mandatorily enrolled in MMC unless the child/youth is otherwise exempt or excluded from enrollment. In addition, effective July 1, 2021, the MMC benefit package was expanded to include Article 29-I VFCA health facility services for eligible children and youth. For more, see the May 2021 Medicaid Update.
Effective April 1, 2023, 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 pharmacy procedure code manual).
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
As an EmblemHealth network provider, you may be responsible for providing and/or coordinating trauma-informed care for MMC children/youth in direct placement foster care and in the care of VFCAs. See guidance documents, including:
- New York Medicaid Program 29-I Health Facility Billing Manual.
- Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care
JP# 61060 10/2023
