Medicaid

There are no copays for covered services

• Primary care provider (PCP) visits
• Immunizations and wellness visits
• Specialist visits
• Urgent care
• Emergency care
• Lab and X-ray services
• Pregnancy services
• Family planning
• Hospital care
• Physical therapy
• Speech and hearing services
• Behavioral health care (mental and substance abuse services)
• Smoking cessation services
• Home health care services
• Disease management for asthma, diabetes and more

See your member handbook for a full list of benefits in your plan.

We believe good dental care is important to your overall health. There are no copays for covered dental services, including:

• Teeth cleaning twice a year
• Oral exams
• X-rays
• Extractions
• Fillings
• Emergency care
• Dentures (removable or partial)
• Orthodontics

Empire offers dental care through LIBERTY Dental, an expert in providing high quality dental services. To find or change your dentist, call LIBERTY Dental at 1-833-276-0847, or visit their website.

There are no copays for covered vision services, including:

• One eye exam every two years
• Prescription glasses every two years

See your member handbook for a full list of vision benefits in your plan.

You can get no-cost rides to your medical appointments. You or your provider should call to schedule your ride at least three days before your appointment.

In New York City and Putnam County

Call Medical Answering Services (MAS) at 1-800-850-5340

You will need:

• Your Medicaid ID number
• Your appointment date and time
• The address where you’re going
• The name of the doctor you’re seeing

In Nassau County

Call LogistiCare at 1-866-481-9488 (TTY 1-866-288-3133)

You will need:

• Your Empire ID number
• Your appointment date and time
• The address where you are going
• The name of the doctor you are seeing

Children and Family Treatment and Support Services are new services provided for Empire Medicaid members under age 21 who have mental health and/or substance use needs. These services help children and their families by providing:

• Assessments to help identify mental health and/or substance use needs early.
• Individual, group and family therapy in a comfortable, familiar setting.
• Rehabilitation services to improve behavioral, emotional and social skills.
• Support for parents and guardians (anticipated to begin July 2019).

Extra Benefits and Healthy Rewards are no-cost, optional programs for eligible members enrolled in our health plan. The programs encourage members to get the care they need to improve their health and create a healthy lifestyle.

Members can redeem these Extras Benefits through the Benefit Reward Hub:

• Diaper program
• Hypoallergenic bedding
• Stroller
• Oral hygiene kit
• Chromebook
• Smartphone gift card

Members can redeem these Healthy Rewards (gift cards) through the Benefit Reward Hub:

• $10 per test result, up to $40 annually, for blood pressure screening
• $50 for a diabetic retinal eye exam
• $5 for completing a What do you know about diabetes? quiz
• $25 per test result, up to $50 annually, for viral load tests with their HIV care team
• $50 for a breast cancer screening (mammogram)
• $50 for a colorectal cancer screening
• $25 every 36 months for a cervical cancer screening (Pap smear)
• $25 for a chlamydia screening
• $25 for a follow-up visit with their provider within seven days of a behavioral health hospitalization
• $25 for yearly well-child visits
• $25 for yearly childhood dental visits
• $25 for Combo 2 adolescent immunizations (shots)
• $25 for Combo 3 childhood immunizations (shots)
• $25 for pregnant members who go to a prenatal visit in their first trimester, or within 42 days of joining our plan
• $50 for a postpartum visit within 7–84 days of delivering their baby
• $50 for five well-baby visits within the first 15 months of life
• $20 per visit, up to $40, for two well-baby visits between 15 and 30 months of life

Log in to the Benefit Reward Hub to redeem your Extra Benefits and Healthy Rewards. You can also call the Healthy Rewards at 888-990-8681 (TTY 711), Monday through Friday from 9 a.m. to 8 p.m. Eastern time. 

If you need help setting up your Empire online account, call Member Services at the number listed on the back of your Empire member ID card.

Starting April 1, 2023, your prescriptions will not be covered by Empire. They will be covered by Medicaid NYRx, the Medicaid pharmacy program.

Referrals

Some services need a referral from your primary care provider (PCP) before getting care. When you need a referral, your PCP will sign a referral form and send you to a doctor in your plan.

You will need to get a referral from your PCP before:

• Going to a hospital for nonemergency care
• Getting medicine from a doctor other than your PCP

You do not need a referral for:

• Women’s health care
• Pregnancy services
• Family planning services
• Emergency services
• School-based health center services
• Adult dental care (ages 21 and over)
• Adult vision care (age 21 and over)
• Behavioral health and substance use disorder services
• Certain doctors for children with special health care needs

Preapprovals

Some services require preapproval or prior authorization. This means that you or your doctor must ask Empire to approve those services or benefits before you get them.

You will need preapproval for:

• Ambulance transportation (emergency air and nonemergency)
• Chiropractic services
• Diagnostic testing
• Durable medical equipment
• End-stage renal disease services
• Vision care for people age 20 and younger
• Home health extended services for people age 20 and younger
• Home health services for people age 21 and over
• Hospice services
• Inpatient acute care hospitalization
• Certain medicines
• Mental health rehab services
• Nurse-midwifery services
• Organ transplant services
• Outpatient hospital services including physical therapy, occupational therapy, speech therapy and surgical procedures
• Pediatric Day Health Care (PDHC) for people ages 20 and older
• Personal Care Services (PCS) for people ages 20 and older
• Physician services including medical assessments, treatments and surgical services
• Podiatry services
• Post-stabilization care services
• Radiology services
• Rehabilitation services: physical therapy, occupational therapy and speech therapy

In Lieu of Services (ILS) are other physical and behavioral health services you may receive instead of those covered by your Medicaid state plan. ILS services:

• Are cost-effective substitutes for covered services and settings.
• Are approved by the State.
• Help us give you more options for your care.

To learn more about ILS and what ILS services we offer, visit the New York State Department of Health website.