MedicaidAdministrativeHigh impact
No Referrals for EmblemHealth’s NYS Sponsored Plans in 2023
EmblemHealth·NY·Provider News
Effective date
Jan 1, 2023
We identified it
Jun 20, 2026
Summary
EmblemHealth is eliminating referral requirements for all NYS sponsored plans (Medicaid, HARP, Child Health Plus, and Essential Plan) starting in 2023. Members can now access specialty care without obtaining referrals from primary care providers.
Action Required
Immediately: Update billing system to remove referral requirements for EmblemHealth Medicaid, HARP, Child Health Plus, and Essential Plan members in New York State. Front desk staff should stop collecting referrals for these plan types. Update scheduling protocols to allow direct specialty appointments without PCP referrals.