Low-Cost Coverage
HMOBlue is a Medicaid Managed Care program sponsored by New York State. It provides very low-cost health insurance coverage for individuals and families who are eligible.
Your Choice of Doctors & Hospitals
You will have a Primary Care Provider (PCP) who will provide most of your care at little or no cost. Your will also have access to a network of more than 13,000 other doctors, urgent care centers, hospitals and specialists when needed.
Some benefits listed below require providers to authorize services. For more information, please call 1-800-650-4359 (TTY 711).
Children’s Family Treatment and Support Services
These new services offer opportunities for children to better meet their behavioral health needs at earlier stages in life to prevent the start or progression of behavioral health conditions. All Children and Family Treatment and Support Services can be delivered in the community where the child/youth lives, attends school, and/or engages in services. These services are available to all Medicaid eligible children under the age of 21 who meet medical necessity criteria.
Effective as of January 1, 2019
- Other Licensed Practitioner (OLP) - This benefit lets children get individual, group, or family therapy where they are most comfortable.
- Psychosocial Rehabilitation (PSR) - This benefit helps children relearn skills to help them in the community.
- Community Psychiatric Support and Treatment (CPST) - This benefit will help connect children with a program to reach set goals, receive extra support managing medication, build relationships and communicate better with family, friends and others.
Effective as of July 1, 2019
- Family Peer Support Services (FPSS) - This benefit offers a variety of different activities and supports to families raising a child who is experiencing a behavioral health challenge.
Effective as of January 1, 2020
- Youth Peer Support and Training - These services provide the training and support necessary to ensure engagement and active participation of youth in the treatment planning process and with the ongoing implementation and reinforcement of skills learned throughout the treatment processes.
- Crisis Intervention - These services provide children/youth who are identified as experiencing a seriously acute psychological/emotional change which results in a marked increase in personal distress and which exceeds the abilities and the resources of those involved (e.g., collateral, provider, community member) to effectively resolve it are eligible for Crisis Intervention.
Office of Mental Health (OMH) Benefits
Current Medicaid Benefit
- Outpatient Clinic - These services include but are not limited to individual and group therapies. These services are aimed to help improve a child’s ability to function in the community. The intensity and extent of visits will vary based on a child’s need.
- Crisis Intervention - Services provided by a crisis team to a child who is experiencing or is at immediate risk of having a psychiatric crisis. The service is designed to interrupt and/or lessen a crisis.
- Psychiatric Inpatient - A hospital-based program that includes 24/7 psychiatric, medical, nursing, and social services to allow for the assessment and/or treatment of a child with a primary diagnosis of mental illness who cannot be fully served in the community.
- Psychological or Neuropsychological Testing – These services are offered to a child who may be suffering from a mental illness. They are similar to a medical test because they allow the professional serving you to better understand your way of thinking. They can also help children and their families to figure out the most appropriate type of treatment based on the results.
Effective as of July 1, 2019
- Assertive Community Treatment (ACT) - A comprehensive and integrated set of psychiatric, psychosocial rehabilitation, case management, and support services for individuals 18 and older. Services are provided by a mobile multi-disciplinary mental health treatment program mainly in the client’s residence or other community locations.
- Personalized Recovery Oriented Services (PROS) - A comprehensive recovery program for individuals 18 and older with severe mental illness. The goal of the program is to integrate treatment, support, and rehabilitation in a manner that facilitates the individual’s recovery.
- Continuing Day Treatment (CDT) - A program that provides individuals 18 and older with mental illness the skills and supports necessary to remain in the community and/or work toward a more independent level of functioning. Participants often attend several days per week with visits lasting more than an hour.
- Partial Hospitalization - A program that provides active treatment designed to stabilize or reduce acute symptoms in a person who would otherwise need hospitalization.
- Comprehensive Psychiatric Emergency Program (CPEP) - A hospital-based emergency program that offers/provides access to crisis outreach, intervention, and residential services; and/or provides beds for the extended observation (up to 72 hours) to adults who need emergency mental health services.
Office of Alcohol and Substance Use Services (OASAS) Benefits
Current Medicaid Benefit
- Outpatient Clinic - Provides treatment services to children who suffer from substance use disorders and their family members and/or significant others. These services are delivered at different levels of intensity and are based on the severity of the child’s needs.
- Medically Supervised Outpatient Withdrawal - Medical management of mild or moderate symptoms of withdrawal within in an OASAS-certified outpatient clinic setting.
- Medically Managed Detoxification (Hospital Based) - Medically managed withdrawal and stabilization in a hospital setting. Designed for children/youth who are acutely ill from alcohol-related and/or substance-related addictions or dependence.
- Medically Supervised Inpatient Detoxification - Provides treatment of moderate withdrawal symptoms and non-acute physical or psychiatric complications.
- Inpatient Rehabilitation - OASAS-certified 24-hour, structured, short-term, intensive treatment services provided in a hospital or free-standing facility.
- Outpatient and Residential Addiction services (Stabilization, Rehabilitative, and Reintegration) - Services of varying levels offered in a residence, providing members with the ability to manage their condition in the safety of a residential setting. Residential services normally last 3+ months.
Effective as of July 1, 2019
- Opioid Treatment Program (OTP) - Certified sites where methadone or other approved medications are administered to treat opioid dependency following one or more medical treatment.
- Outpatient Rehabilitation - Assist individuals with chronic medical and psychiatric conditions. Higher staff to client ratio compared to other outpatient levels.
- Outpatient Services - These services include but are not limited to individual and group therapies, Opioid Treatment Programs, and Outpatient Rehabilitation . These services are aimed to help improve a child’s ability to function in the community. The intensity and extent of visits will vary based on a child’s need.
If you are under 21 years old and have federal Social Security Insurance (SSI) disability status or have been determined Social Security Insurance-Related by New York State, use your State Medicaid Card for these Services.
Please visit the NYS Department of Health website for more information about these services.
Behavioral Health and Addiction Resources
- Listing of Local Departments of Social Services by County
- NYS Department of Health (DOH)
- New York State Office of Mental Health (OMH)
- Office of Alcoholism and Substance Use Services (OASAS)
- NYS Office of Children and Family Services (OCFS)
- Office for People with Developmental Disabilities (OPWDD)
- Substance Use and Mental Health Services Administration (SAMHSA) site provides general mental health and substance use information along with news and updates. There is also a Behavioral Health treatment locator tool that is available.
- American Academy of Child and Adolescent Psychiatry (AACAP) offers information and resources about mental illness and treatment.
- The American Psychiatric Association offers information about mental illness and treatment.
- National Institute of Mental Health site provides general mental health and substance use information.
- Children's Bureau offers a variety of resources aimed to protect vulnerable children through prevention, treatment, training and advocacy.
- Child Welfare Information Gateway offers information, resources, and tools covering topics on child welfare, child abuse and neglect, out-of-home care, adoption, and more.
- Project TEACH a program that strengthens and supports the ability of New York’s pediatric primary care providers (PCPs) to deliver care to children and families who experience mild-to-moderate mental health concerns.
First Episode Psychosis (FEP) Resources
- OnTrackNY is an innovative treatment program for adolescents and young adults who have had unusual thoughts and behaviors, or who have started hearing or seeing things that others don’t. OnTrackNY helps people achieve their goals for school, work, and relationships. Programs are located throughout New York State.
Transitional Age Youth (TAY) Resources
- NYS Office of Mental Health (OMH) information for children, teens and their families on services to help identify emotional health needs and provide treatment or support.
- NAMI offers local support groups. A state search can be done find all the support groups in that state listed by county.
Additional Resources
NY Connects
1-800-342-9871
NY Connects is your trusted place to go for free, unbiased information and assistance. They can help you link to long-term services and supports, such as home care, transportation and meals. Our goal is to help individuals remain in their homes as long as possible.
County Mental Hygiene Department Websites:
Advocacy Organizations/Volunteer Opportunities/Support Services/Community Forums
There are many opportunities available for members and their families to get involved in volunteer activities, committees, work groups, community forums and connect with advocacy services. Listed are some of the community organizations that are available to our members and their families for support, guidance and advocacy.
We also offer Behavioral Health Case Management services to our members and their families. Our Behavioral Health Case Managers can assist you with understanding your insurance benefits, understanding your treatment options, locating and connecting with area treatment providers for mental health and substance use treatment and much more. If you or a loved one have questions or need assistance please reach out to one of our Behavioral Health Case Managers who can be reached at 1-844-694-6411 (TTY 711). A Behavioral Health Case Manager will be able to assist you during our normal business hours. If calling after hours you will be connected with a live nurse through Fonemed.
We also offer Behavioral Health Advocacy services to our members and providers when a request for treatment has been denied. Our Behavioral Health Advocate is available to assist you and your provider in understanding the denial decision as well as with the process for pursuing appeals, and in identifying participating providers. Our Behavioral Health Advocate can be reached at 1-844-635-2662 (TTY 711).
- Mental Health Association offers listings of services and support groups for Monroe, Livingston and Wyoming Counties.
- National Eating Disorder Association will provide information on the diagnoses and also provides assistance with finding eating disorder providers and supports.
- Depression and Bipolar Support Alliance (DBSA) offers local support groups that can be searched by state.
- Alcoholics Anonymous is a group of peers open to everyone who has struggled with alcohol. This site offers information on AA.
- New York State Alcoholics Anonymous offers support groups run by peers offering support and guidance. This site provides a listing of area AA meetings.
- Narcotics Anonymous offers support groups run by peers offering support and guidance to those who wish to pursue and maintain a drug-free lifestyle. This site offers information on Narcotics Anonymous and also a listing of area NA Meetings.
- Spiritus Christi Church is located in the Rochester area and offers free mental health services and support groups.
- Secular Organizations for Sobriety is an informational site on SOS which is a nonprofit network of autonomous, nonprofessional local groups dedicated solely to helping individuals achieve and maintain sobriety. There are groups meeting in many cities throughout the US and other countries.
- Al-Anon offers support to friends and families of problem drinkers. This site offers information on Al-Anon and local Al-Anon support groups.
- National Council on Alcoholism and Drug Dependence Rochester area organization offers community education on addiction-related topics.
Some benefits listed below require providers to authorize services. For more information, please call 1-800-650-4359 (TTY 711).
Children’s HCBS benefits are designed to offer support and services to children in non-institutionalized settings that enable them to remain at home and in the community. These services are intended to assist children in being successful at home, in school and other environments to help maintain them in their community and avoid higher levels of care (such as long-term care facility or psychiatric inpatient care).
Medicaid Managed Care children must be under 21 years old and determined eligible to receive HCBS services through clinical evaluation and documentation of need in a personalized plan of care; services may include the following:
Caregiver Family Advocacy and Support Services
- Caregivers and families can get training and education to make informed and empowered choices for children with developmental, medical, mental health, and/or substance use needs
- Maintain and strengthen children and youth’s Independence In the community
- Find available resources and services that meet child/youth and family needs
- Community Habilitation - Provides help with learning social and daily living skills and health related tasks. For example: learning to cook and eat healthy; take part in community activities; communicate effectively; be independent; and make informed choices.
- Day Habilitation - Provides help with learning social and daily living skills that takes place in a non-residential setting, separate from the child’s residence. For example: building relationships; take part in community activities; gain independence; and make informed choices.
- Prevocational Services - Youth aged 14 and older with disabilities can learn skills to help get ready for paid work, or volunteer work that matches their interests. Skills can include: communicating with supervisors, coworkers, and customers; workplace problem-solving; career planning; and workplace safety.
- Supported Employment - Youth aged 14 and older with disabilities who are ready for a job can get help to stay in a steady job that pays wages. Services can include, but are not limited to: Help with finding a job that matches their skills and interests; job coaching; benefits support; help with advancing career goals; and other work place support services.
- Respite Services (Planned/Crisis) - Planned respite services provide short term relief for families/caregivers and support the child’s men¬tal health, substance use and/or health care goals. Crisis respite is short term relief from a mental health, substance use and/or health care crisis event that without this support the child would need a higher level of care. May be delivered at home, in the community, or in another allowable location.
- Palliative Care - Provides specialized care focused on providing relief from the symptoms and stress of a chronic condition or illness. The goal is to improve quality of life for both the child and the family. Types of services may include counseling and support, expressive therapy, massage therapy and pain and symptom management.
- Effective 7/1/2024, requests for Environmental Modifications, Vehicle Modifications and Adaptive and Assistive Technology are no longer reviewed and reimbursed from Managed Care Plans. The approval, the review, payment, and approval of all Children's Environmental Modifications, Vehicle Modifications, and Adaptive and Assistive Technology have transitioned to the Children's Health Home of Upstate NY (CHHUNY), in conjunction with the New York State Department of Health (NYS DOH).
- Adaptive and Assistive Technology - Provides technological aids and devices which enable the person to accomplish daily living tasks that are necessary to support the health, welfare and safety of the child.
- Environmental & Vehicle Modifications - These services provide physical adaptations to the home and/or vehicle that are identified as necessary to support the health, welfare and safety of the child or that enable the child to function with greater independence.
Effective July 1, 2021, Medicaid Managed Care Plans are responsible for covering the following 29-I Health Facility Services for enrollees who are in the care of a Voluntary Foster Care Agency (VFCA).
29-I Licensed Health Facilities provide a range of services to children in foster care including early childhood and special education services, adoption services as well as preventive, physical and behavioral health services. These facilities are licensed by the Office of Children and Family Services.
Their mission is to advocate for children and families in need of care and to promote safe and stable environments. 29-I Health Facilities serve children up to twenty-one years of age.
Available Services
29-I Licensed Health Facilities provide all Core Limited Health-Related Services. The five Core Limited Health-Related Services play a vital role in assuring all necessary services are provided in the specified time frames and delivered in a comprehensive and coordinated manner for children/youth in placement.
Core Health-Related Services
Medical necessity must be determined by a licensed practitioner for Core Limited Health Related Services at time of admission before services are delivered.
- Skill Building
- Nursing Services
- Medicaid Treatment Planning and Discharge Planning
- Clinical Consultation/Supervision Services
- VFCA Medicaid Managed Care Liaison/Administrator
Other Limited Health-Related Services
29-I Licensed Health Facilities may also choose to provide Other Limited Health-Related Services to children in the care of a VFCA for up to one (1) year post discharge.
- Children and Family Treatment Supports and Services (CFTSS)
- Children’s HCBS
- Screening, diagnosis and treatment services related to developmental, physical and behavioral health needs.
- Other Limited Health-Related Services do not include the following services, which should be provided by Medicaid participating providers (i.e. essential community providers) and billed directly by these providers to MMCPs/Medicaid FFS: surgical services, dental services, orthodontic care, general hospital services including emergency care, birth center services, emergency intervention for major trauma, and treatment of life-threatening or potentially disabling conditions.
- Member Services: 1-800-650-4359 (TTY 711)
- Hours: Monday - Friday: 8 a.m. - 6 p.m. EST
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