MedicaidAdministrativeMedium impact
Removal of Specialty Referral Requirement for Children in Foster Care
EmblemHealth·Provider News
Effective date
Sep 1, 2021
We identified it
Jun 20, 2026
Summary
EmblemHealth has eliminated the requirement for primary care referrals when providing specialty care services to Medicaid children age 21 and under who are placed with 29-I Voluntary Foster Care Agencies. This streamlines access to specialty services for foster care children whose healthcare needs frequently change.
Action Required
Immediately: Billing team should update patient eligibility verification procedures to identify Medicaid children in 29-I VFCA placement. Front desk staff must stop requiring referrals for specialty visits for these patients. Update scheduling protocols to allow direct specialty appointments without PCP referral verification for this population.