What is Medicaid Managed Care?

Medicaid Managed Care is a comprehensive prepaid health services program providing quality health care to Public Assistance and Medicaid eligible individuals. It was developed to remedy deficiencies in services delivered under traditional Medicaid. Since the program began, the number of physicians and services available has increased dramatically. The county provides Managed Care through contracts with five health plans that each provide the same range of primary care and specialty services.

• Capital District Physician's Health Plan (1-800-777-2273)
• Fidelis Care New York (1-888-343-3547)

Both health plans offers these services through a network of providers who manage all the members' health care needs on a 24-hour a day basis:

• Primary care
• Sick care
• Emergency care
• Immunizations
• Laboratory services
• Transportation
• Mental health & substance abuse services (SSI recipients access these services outside of managed care)
• Optometry (including glasses)
• Dental (excluding orthodontia)
• Family planning (through members' health plan or any Medicaid provider)

The benefit package is the same for all health plans. All offer supplemental programs like parenting and smoking cessation. Members get health plan identification cards that enable them to access services. Members use their Medicaid cards to get prescriptions and to access family planning services outside their plan's provider network. Great emphasis is placed on preventive care to improve overall health and to reduce the number of emergency room visits.  Enrollees are advised to go to the hospital for treatment of any medical emergency.

Schenectady County functions as regulator over the health plans with ultimate oversight belonging to New York State. The county performs all enrollment and disenrollment, and approves marketing proposals. Please direct questions to the Managed Care Help Line at 1-800-549-7650 from 9:00 a.m. until 5:00 p.m. weekdays.