About health plans: learn the basics, get your questions answered.
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Who Does Not Have to Join a Health Plan
See a complete list of who does not have to join a plan or cannot join a plan.
Some Medicaid members cannot join a plan because of their medical needs or other reason. They are ‘excluded’. Others are not required to join a health plan but they can if they want to. They are ‘exempt’. If you have questions, call New York Medicaid Choice. Counselors will be glad to answer your questions. Call: 1-800-505-5678. TTY: 1-888-329-1541.
Exemptions
You are not required to join a plan but you can if you want to.
- American Indian/Alaskan Native
- Residents of an Article 819 long-term alcohol or substance use facility
- People who live in facilities for the developmentally disabled
- People being treated for a chronic medical condition for 6 months or longer by a Medicaid specialist who is not in a Medicaid health plan. (This exemption is limited to a 6 month period and for one time only)
- Adults in waiver programs: Nursing Home Transition and Diversion (NHTD), Office of People with Developmental Disabilities (OPWDD), Traumatic Brain Injury (TBI)
Exclusions
You cannot join a plan because of your medical needs or other reason.
- People in a hospice program at the time of enrollment.
- Children or adults who live in state psychiatric or residential treatment facilities
- People who will get Medicaid only after they spend some of their own money for medical needs (spend-down cases)
- People with other full benefit health insurance
- Infants living with their mothers in jail or prison
- Children who are blind or disabled and living apart from their parents for 30 days or more
- People eligible for TB services only
- People eligible for the Medicaid Cancer Treatment Program: Breast, Cervical, Colorectal and Prostate Cancer (MCTP)
Reach Us
1-800-505-5678
1-888-401-6582
(Long term care customer services)
TTY 1-888-329-1541
Monday - Friday
8:30 a.m. - 8:00 p.m.
Saturday
10:00 a.m. - 6:00 p.m.
Quick Assist
Have questions? We’re here to help. Our counselors will be glad to answer your questions. We can also help you choose a plan over the phone. All languages are spoken.