New York Medicaid: Specialist referral requirement changes

As of Jan. 1, 2026, we’re no longer requiring referrals for follow-up visits with the following specialist categories within 7 days of a UnitedHealthcare Community Plan of New York member’s discharge from the emergency room or hospital:

However, if additional visits are needed beyond the follow-up visit, you’ll need to request a referral from our member’s primary care provider (PCP) to continue to see the member after the first visit.

If the member isn’t engaged with their PCP or they don’t know who their PCP is, they should call the Member Services phone number on the back of their ID card.