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UnitedHealthcare Community Plan
The New York State Medicaid Managed Care Plan is offered through UnitedHealthcare Community Plan. It’s for New York State residents who meet the income or disability requirements.
To find out if UnitedHealthcare Community Plan is offered in your county, please call 1-888-617-8979. A representative will contact you to schedule an appointment to help you apply.
More information on eligibility and enrollment can be found on the New York State of Health website.
For more information about Child Health Plus or Medicaid, call New York Health Options at 1-800-541-2831.
This plan is available in the following counties:
Albany, Bronx, Broome, Cayuga, Chautauqua, Chemung, Chenango, Clinton, Columbia, Dutchess, Erie, Essex, Franklin, Fulton, Genesee, Greene, Herkimer, Jefferson, Kings, Lewis, Livingston, Madison, Monroe, Nassau, New York, Niagara, Oneida, Onondaga, Ontario, Orange, Orleans, Oswego, Queens, Rensselaer, Richmond, Rockland, Schenectady, Seneca, St. Lawrence, Suffolk, Tioga, Ulster, Warren, Wayne, Westchester, Wyoming, and Yates.
UnitedHealthcare continues to partner with state and local public health departments, following guidance and protocols appropriate to our members that are provided by the U.S. Centers for Disease Control and Prevention (CDC), and state and local public health departments that are appropriate for our members. Please review the UnitedHealthcare Coronavirus (COVID-19) Information. To learn more, go to CDC.gov.
COVID-19 NY State PPE Fee Guidance
The New York State Department of Financial Services (DFS) recently issued guidance stating that care providers should not charge members additional fees for items such as personal protective equipment (PPE). DFS expects New York care providers to refund any of these charges paid by the member that were more than the member’s financial responsibility on a claim. If you have questions, you may contact your provider or call the number on the back of your card for assistance with filing a complaint.
Find providers and coverage for this plan.
Search for doctors, hospitals and specialists.
Find medications covered by this plan.
Find a pharmacy near you.
Find a dentist near you.
Benefits & Features
Adult Day Care
Companionship is important. Adult day care provides care and companionship for seniors who need extra help during the day.
Caregivers also benefit, knowing their loved one is well cared for and safe during the day.
Adult day care can provide:
- Social connections and friendship.
- Bathing and personal care.
Asthma and COPD Care
Individual care to help control asthma, allergies or COPD symptoms.
Do you or your child have trouble managing asthma, allergies or COPD symptoms? A nurse who specializes in breathing issues can really help. You'll get a customized treatment plan and medicine to:
- Manage flare-ups.
- Reduce symptoms.
- Let you or your child stay active.
Do you or your child have a serious health problem or a high-risk pregnancy? If so, and you or your child qualifies, we offer case managers that can:
- Explain medical terms in plain language.
- Coordinate your doctor appointments.
- Provide your care team with your medical records.
Your case manager will stay with you or your child throughout the medical journey. He or she will:
- Think beyond your medical needs.
- Make sure you have support at home.
So you or your child can focus on getting better.
Choice of Birth Center
Where you have your baby is an important choice. That's why you can pick from hundreds of hospitals across New York.
We encourage you to tour the hospital's birthing center. This way you will be familiar with it. And you'll be more relaxed when you have your baby.
Choice of Doctor
You get a primary care physician (PCP), who is your main doctor. Use the Doctor Lookup tool to see if your doctor is in our network.
If you don't have a doctor or if your doctor is not in our network, we can help you find a new one close to you.
Your PCP is your main doctor for:
- Preventive care.
- Treatment if you are sick or injured.
- Referrals to specialists for certain conditions.
Checkups and emergency care are covered.
Exams and cleanings every six months help keep teeth and gums strong and healthy. If there is a dental problem that needs to be fixed, that’s covered as well.
If you have diabetes, you may need insulin, needles, wipes and glucose strips. We cover all that and more.
Our plan also steps up with services to help you manage your diabetes, including:
- Classes on keeping diabetes in control.
- Coordinating doctor care.
- Nutrition and diet.
Durable Medical Equipment
Your health and safety at home are important.
Our plan covers medical equipment ordered by your doctor or case manager. This can include supplies like:
- Diabetic supplies.
- Hospital beds.
- Wheelchairs or walkers.
Emergency Response System
If you are at risk for a fall or sudden illness, an emergency call system can really help. It sends an urgent request for someone to check on you and help you.
A loss can take many different forms. And you may get lots of suggestions on what to do. Grieving is part of the healing process.
If a recent loss has made you sad or unhappy, help is available. Our plan offers counseling and support during the grieving process. Our team will work with you to find a counselor or program to help you adjust to your loss.
Healthy First Steps®
The Healthy First Steps team is here for you. Our program will help you take the right steps to keep you and your baby healthy.
We will help you:
- Choose a pregnancy provider and a pediatrician (child’s doctor).
- Schedule visits and exams and arrange rides to your visits.
- Get supplies, including breast pumps for nursing moms.
- Connect with community resources such as Women, Infants and Children (WIC) services.
Trouble hearing can affect your everyday life in many ways. Our plan includes services and support to help protect your hearing.
Our plan covers:
- Exams, therapy and tests.
- Hearing aids.
Home Meal Delivery
Taking care of the basics, like cooking, can be hard to do yourself after an illness or sickness.
If you are receiving personal care services, you may need extra help to get through the tough times. We'll step in to bring nutritious meals to you. You can get up to 10 meals delivered each year.
After surgery or a serious illness you may need extra help with day-to-day tasks like cleaning, cooking or dressing. You may even need an in-home medical visit to check on how well you are healing. With approval, our plan covers:
- Medical equipment like hospital beds, walkers or wheelchairs.
- Disposable medical supplies.
- In-home medical visit.
This plan pays for all expenses related to a hospital stay, so you can rest and heal.
Hospitalization coverage includes:
- Nursing care.
- Room and board.
- Supplies and equipment.
- Treatment and therapies.
- Diagnostic tests and exams.
And after you leave the hospital, you are not alone. We make sure you get follow-up care to continue healing at home.
Sometimes you might need a little help understanding your health care options. With us, you have someone you can call Monday – Friday 8 a.m. – 6 p.m. EST. We'll answer your questions simply and completely.
We can also help you find:
- Home care providers.
- Dentists and vision providers.
- Adult day health centers.
Mental Health/Substance Use Disorder
Addiction can happen to anyone, any family, at any time according to the New York State Office of Alcoholism and Substance Abuse Services (OASAS).
UnitedHealthcare is here to assist you in all your healthcare needs. We have trained professionals who are experienced in understanding Substance Use Disorder and able to help you get treatment or give you information that will help you make decisions about your healthcare. You or your provider can call Optum Behavioral Health anytime for help at 1-844-206-1399.
Covered services include:
- All inpatient mental health and substance use disorder services (including alcohol and substance use disorder).
- Most outpatient mental health services (contact plan for specifics).
- Medicaid recipients who receive SSI or who are certified blind or disabled get mental health and substance use disorder services from any Medicaid provider by using their Medicaid Benefit Card.
- Detoxification services are covered by UnitedHealthcare Community Plan as a benefit.
You will not have a copayment for care and services covered by our plan, other than for prescription drugs.
That means you will pay nothing for covered services, including:
- Preventive care.
- Annual checkups.
- Routine dental or vision care.
You pay nothing for your child's care and services covered by our plan.
Sometimes you may need continued care after you leave the hospital or urgent care.
If your health is at risk after a serious illness, surgery or injury, a nurse will visit you at home to:
- Provide medical care for you.
- Answer your questions and concerns.
Healthy eating goes a long way to helping you stay at your best.
A nutritionist can meet with you to review your eating habits and food choices.
You'll come away with new ideas for:
- Making good choices for quick meals and snacks.
- Preparing healthy meals on a budget.
Knowing what's wrong and finding it early can make all the difference.
Our plan covers:
- Labs and testing.
- X-rays, scans and other imaging.
We'll help you get the information needed to help improve your health or be your best.
Palliative Care Services
Our plan offers the following palliative care services:
- Pain Management
- Massage Therapy
- Expressive Therapy
Sometimes the basics are hard to do yourself after an illness or injury.
If needed, we provide someone to help with:
A pregnancy is a journey you'll want to make with the help of friends, family and a pregnancy doctor, or OB-GYN.
All of your recommended prenatal clinical visits and tests are covered.
At these visits, the clinic will:
- Make sure you and your baby are healthy.
- Explain what to expect at each stage of your pregnancy.
- Answer your questions.
You know the bad health effects of smoking.
You know you need to quit. We support you while you quit with the help of coaches and supplies. The only thing you won't get from us is a lecture.
After a serious illness, surgery or injury, you may need extra nursing and therapy.
If needed, our plan covers short stays in a rehabilitation center where you can heal. Included are:
- Nursing home services.
- 24-hour nursing care.
- Help with activities of daily living.
- Physical, occupational and speech therapy.
Do you have family members or friends who care for you at home? If so, we want to support their hard work too. That’s why we provide respite care to give your caregivers a rest. Respite care offers caregivers time away from their loved one who is ill or has special care needs.
Shots and Immunizations
Routine shots help keep you healthy.
So, our plan covers:
- Recommended shots and vaccines.
- Diagnostic tests and exams.
See life more clearly with routine eye exams and glasses, if needed.
We also include:
- Prescription lenses.
- Medicaid approved frames.
- New eyeglasses every two years.
This benefit is offered by March Vision Care.
Well visits with your doctor can help you stay healthy. These visits can catch health problems early, so they can be treated.
Preventive services include:
- Checkups for adults and children.
- Well-baby care.
- Care for women expecting a baby.
- Routine shots and tests.
There are no copayments for preventive care.
UnitedHealthcare Community Plan Member Handbook
Renew Your Coverage
National Flu Campaign Questions and Answers
Flu Shot Reminder
NY Medicaid Member Notification PCP Referral Letter
Orthopedic Prior Authorization Requirements
Notices and Bulletins
Member Handbook Updates
Specialty Referral Requirements
Benefit Update for Children and Family Treatment and Support Services (CFTSS)
Starting January 1, 2020, UnitedHealthcare Community Plan will cover more Children and Family Treatment and Support Services (CFTSS). These services help children and their families improve their health, well-being, and quality of life.
Harm Reduction Services
Starting July 1, 2018, you will be able to get Harm Reduction Services as part of your Medicaid Managed Care benefit package. Harm Reduction Services will offer a complete patient-oriented approach to the health and wellness of substance users.
Information about Enterovirus D68
Emergency Services and "Surprise" Bills
Information on Emergency Services and "Surprise" Bills
Institution for Mental Disease In Lieu of Service Benefit
Institution for Mental Disease In Lieu of Service Benefit information
New York Independent Assessor MMC Guidance and Member Notice
New York State Department of Health has stated – Medicaid recipients should receive breast cancer surgery services at high volume facilities (those facilities performing 30 or more mastectomy and lumpectomy procedures associated with a breast cancer diagnosis on average over a three-year period).
See the listing of low-volume facilities that will not be reimbursed for breast cancer surgeries provided to Medicaid recipients.
This policy does not affect a facility's ability to provide diagnostic or excisional biopsies, and post–surgical care (chemotherapy, radiation, reconstruction, etc.) for Medicaid patients.
Clinical Practice Guidelines
UnitedHealthcare Community Plan has practice guidelines that help providers make healthcare decisions. These guidelines come from nationally recognized sources. UnitedHealthcare Community Plan has practice guidelines for preventive health and other health conditions.
View the entire list of guidelines or call our Member Services at 1-800-493-4647 (TTY: 711) to request a printed copy.
Member Newsletters 2016 - Current
Member Newsletters Prior to 2016
Preventive Health Information
Helpful information around preventive service.
Health Tips Flyer
Men's Health Flyer
UnitedHealthcare Community Plan
This link is being made available so that you may obtain information from a third-party website. This link is provided solely as a convenience and is not an endorsement of the content of the third-party website or any products or services offered on that website. We are not responsible for the products or services offered or the content on any linked website or any link contained in a linked website. We do not make any representations regarding the quality of products or services offered, or the content or accuracy of the materials on such websites.