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. You 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 or for TTY/TDD services call 1-800-662-1220.
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.
Available beginning 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.
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.
Office of Alcohol and Substance Abuse 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.
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: https://www.health.ny.gov/health_care/medicaid/redesign/behavioral_health/children/proposed_spa.htm
Crisis Services Resources
Suicide Prevention Lifeline
Website: www.suicidepreventionlifeline.org 24-hour, toll-free, confidential suicide prevention hotline available to anyone in suicidal crisis or emotional distress. Your call is routed to the nearest crisis center in the national network of more than 150 crisis centers.
New York Suicide and Crisis Hotlines
Crisis numbers are listed by City, County, or Service Area.
SAMHSA's National Helpline
Website: https://www.samhsa.gov/find-help/national-helpline Also known as, the Treatment Referral Routing Service, this Helpline provides 24-hour free and confidential treatment referral and information about mental and/or substance use disorders, prevention, and recovery in English and Spanish.
Veteran's Crisis Line
Website: https://www.veteranscrisisline.net Connects veterans in crisis (and their families and friends) with qualified, caring Department of Veterans Affairs responders through a confidential, toll-free hotline, online chat, or text.
Behavioral Health and Addiction Resources
Substance Abuse and Mental Health Services Administration (SAMHSA) offers crisis support and general information on mental health and substance use.
Substance abuse and Mental Health Services Administration 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 & 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.
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.
11 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 844-694-6411. 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 844-635-2662.
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.
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 provides information on local Al-Anon support groups.
National Council on Alcoholism and Drug Dependence Rochester area organization offers community education on addiction related topics.
Family Recovery Network support group providing information and networking for families of people struggling with substance use in the greater Rochester, NY area.