February 17, 2022

New York Medicaid: Providers may be responsible for coordinating services for foster care

In compliance with the New York Medicaid Program 29-I Health Facility Billing Manual, UnitedHealthcare network providers may be responsible for providing and/or coordinating services for a new group of Medicaid Managed Care (MMC) enrollees who require trauma-informed care: children/youth in direct placement foster care and in the care of Voluntary Foster Care Agencies (VFCA).

As of July 1, 2021, children/youth in direct placement foster care in New York City and children/youth placed in foster care in the care of VFCAs statewide are mandatorily enrolled in MMC unless the child/youth is otherwise exempt or excluded from enrollment. In addition, the MMC benefit package has been expanded to include Article 29-I VFCA Health Facility services for eligible children and youth.

For more information, please see the May 2021 New York state Medicaid update article related to this VFCA transition, or the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance documents.

Initial medical assessment requirement
Upon placement into foster care, a child/youth is required to have an initial medical assessment within the first 30 days of the child/youth’s placement. The child/youth may utilize any primary care provider (PCP) or qualified practitioner in the MMC plan’s network for the purposes of this initial medical assessment.

Pharmacy benefit requirements
The pharmacy benefit requirements for children/youth placed in foster care include, but are not limited to, rapid replacement of medically necessary prescriptions, transitional fills for children/youth newly placed in foster care and out-of-network access to pharmacies when a child/youth placed in foster care is placed outside the MMC plan’s service area.

For assistance addressing questions or discrepancies with the assigned PCP to a child/youth in foster care, please contact the UnitedHealthcare foster care liaison:

After-hours contacts:

  • Providers: Call 866-362-3368, select option 8
  •  Members: Call 800-493-4647