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Managed Care

Program Overview:

Herkimer County currently has a mandated Medicaid Managed Care program through three Medicaid Managed Care health plans. When a client joins a Medicaid Managed Care health plan, he/she uses the providers and hospitals that are in that plan. They choose their own doctor or nurse practitioner who will keep track of all their health care. This person is called Primary Care Provider (PCP). The PCP will refer the individual to a specialist when deemed necessary. Under Family Health Plus, all services are received from the selected managed care plan.

The Manged Care Unit provides enrollment/disenrollment into these Managed Care Plans for Medicaid and Family Health Plus eligible individuals. It also assists with billing issues.

Eligibility Criteria:

Serves Herkimer County residents eligible for Medicaid and Family Health Plus.

Referral Process:

Referral occurs during eligibility determination for Temporary Assistance, Medicaid and Family Health Plus. Plan marketers are on-site at the Department of Social Services.

Client Fees:

There are no co-pays when a recipient is in a Medicaid Managed Care health plan. The client will receive his/her own health plan card that is separate from the Common Benefit Identification Card (CBIC).

FAQs:

Q. What are the two Medicaid Managed Care Health Plans and how can they be reached?
A. Fidelis Care NY - 1-888-343-3547 |  Excellus HMO Blue Option - 1-800-919-8809

Q. How does a client choose a health plan?
A. In choosing a health plan, the recipient should think about the doctors he/she wants, the services he/she and his/her family need, and the health plans available. It is important that they make sure the doctor they want to see is in the health plan they choose. After a plan is chosen, the client must use the hospital, clinics and doctors that work with that plan.

School Intervention Program

Child Preventive Services and the SIP Program provide supportive assessment and referral services to Prevent the placement of a child into foster care ,Return a child currently in foster care to his/her parents sooner than would otherwise be possible and to Prevent the re-placement of a child into foster care

Child Protective Services

Each county in New York State has a Child Protective Services (CPS) Unit, which investigates reports of suspected child abuse and neglect received from the New York State Child Abuse and Maltreatment Register (Hotline) located in Albany.

Child Support Services

The Child Support program provides custodial parents with assistance in obtaining financial support and medical insurance coverage for their children by locating parents, establishing paternity, establishing support orders and collecting and distributing support payments.

Foster Care

Foster Care is provided to children under the age of 18 who are in need of an alternate living arrangement.

Home Energy Assistance Program

In an effort to help income eligible individuals cope with higher fuel bills of winter, NYS participates in the Federal funded "Home Energy Assistance Program", commonly known as HEAP.

Indigent Burials

The Commissioner of Social Services is responsible for the burial of any Herkimer County resident that meets the criteria outlined in the Indigent Burial Policy adopted by the Herkimer County Legislature on September 11, 2019.

Managed Care

Herkimer County currently has a mandated Medicaid Managed Care program through three Medicaid Managed Care health plans.

Medicaid

Medical Assistance is help for people who cannot pay for all of their medical care.

Person in Need of Supervision (PINS) Diversion Program

The Family Support PINS Diversion Program began in February 2003 and is the point of entry for PINS Diversion services in Herkimer County. Services provided include a formal assessment, in home counseling, case management, family support, respite and mentoring for at-risk youth.

Supplemental Nutrition Assistance Program

SNAP, a program of the US Department of Agriculture, is provided to insure that the nutritional needs of income eligible persons are met.

Temporary Assistance

Temporary Assistance is temporary help for needy adults and children. If an applicant is unable to work, can't find a job or his/her job does not pay enough, Temporary Assistance may be able to pay for some household expenses.

Adoption Services

Services range from assessing a child to securing an adoptive home, to assisting parent(s) under appropriate circumstances to surrender a child, to the recruitment and evaluation of prospective adoptive parents.

Adult Protective Services

Adult Protective Services is a service provided to individuals who are 18 years of age or older, Unable to protect his/her own interests due to lack of awareness or incompetence, Incapacitated due to a physical or mental impairment , In danger of being harmed or threatened with harm , Have an unmet need such as failure to receive adequate food, shelter, or clothing, Have no one willing or able to assist responsibility

Alternatives in Long Term Care Program

The Alternatives in Long Term Care Program provides a central access point to long term home care services for all Herkimer County residents with chronic long-term home care needs.

Child Care Assistance (Day Care)

Day care assistance is an income eligible program available to assist working parents. The Day Care Unit keeps a current listing of registered day care homes in Herkimer County, which is available to the general public.

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Employment Assistance

The goal of the Employment Unit is to help applicants and recipients of Temporary Assistance and the Supplemental Nutrition Assistance Program benefits to achieve self-sufficiency.

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