MedicaidCoverageMedium impact
Medicaid Managed Care for Foster Care Members
EmblemHealth·NY · Family Medicine, General Practice, Pediatrics·Provider News
Effective date
Apr 1, 2023
We identified it
Jun 20, 2026
Summary
Effective April 1, 2023, foster care children/youth in Medicaid Managed Care had their pharmacy benefits transferred to NYRx, but physician-administered drugs, DME, prosthetics, orthotics, and supplies remain covered by EmblemHealth when billed as medical claims. Foster care children require initial medical assessments within 30 days of placement and can see any in-network PCP for this assessment.
Action Required
Immediately: Billing team must ensure physician-administered drugs, DME, prosthetics, orthotics, and supplies for foster care children are billed as medical/institutional claims to EmblemHealth, not pharmacy claims. Front desk staff should not turn away foster care children for PCP discrepancies - call EmblemHealth at 855-283-2146 to resolve. Schedule initial medical assessments within 30 days for newly placed foster care children.