Medicaid Managed Care

Member Handbook
For more information on the latest behavioral health services available, please review your Member Handbook.
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Member Handbook Insert - Updated Children's Home and Community Based Services
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Member Handbook Insert – Changes to Service Authorization Timeframes
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Medicaid Managed Care – Handbook Addendum
Addendum to the Medicaid Managed Care Member Handbook for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program.
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Covered Services
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Pharmacy Benefit Change Alert
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Pharmacy Benefit Change Alert – Members Who Have Medicare
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Medicaid Prescription Drug and OTC Formulary

Medicaid members enrolled in Healthfirst Medicaid Managed Care receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Use the link above to search the list of drugs covered by NYRx.

Institution for Mental Disease (IMD) In Lieu of Service (ILS) Benefit

Personal Wellness Plan

Member Handbook
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- Español
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Member Handbook Insert – Changes to Service Authorization Timeframes
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- English
- Español
- 中文
Personal Wellness Plan – Handbook Addendum
Addendum to the Personal Wellness Plan Member Handbook for the Integrated Benefits for Dually Eligible Enrollees (IB-Dual) Program.
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- English
- Español
- 中文
Covered Services
- View PDF:
- English
Pharmacy Benefit Change Alert
- View PDF:
- English
- Español
- 中文
Pharmacy Benefit Change Alert – Members Who Have Medicare
- View PDF:
- English
- Español
- 中文

Medicaid Prescription Drug and OTC Formulary

Medicaid members enrolled in Healthfirst Medicaid Managed Care receive their prescription drugs through NYRx, the Medicaid Pharmacy Program. Use the link above to search the list of drugs covered by NYRx.

Institution for Mental Disease (IMD) In Lieu of Service (ILS) Benefit

Child Health Plus

Member Handbook
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Covered Services
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Child Health Plus Formulary
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- English

Essential Plans

Member Handbook
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- Русский
Summary of Benefits – Essential Plan 1
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Summary of Benefits – Essential Plan 2
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Summary of Benefits – Essential Plan 3
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Summary of Benefits – Essential Plan 4
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Essential Plan Formulary
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Essential Plan Formulary Changes
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Marketplace Leaf & Leaf Premier Plans

Platinum

Member Handbook
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Summary of Benefits – Platinum Leaf Premier Plan
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Summary of Benefits – Platinum Leaf Plan
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Leaf and Leaf Premier Plan Formulary
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- English
Leaf Premier Plan Formulary Changes
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- English
Leaf Plan Formulary Changes
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- English

Gold

Member Handbook
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Summary of Benefits – Gold Leaf Premier Plus Plan
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Summary of Benefits – Gold Leaf Premier Plan
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Summary of Benefits – Gold Leaf Plan
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Leaf and Leaf Premier Plan Formulary
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- English
Leaf Premier Plan Formulary Changes
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- English
Leaf Plan Formulary Changes
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- English

Silver

Member Handbook
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- Русский
Summary of Benefits – Silver Leaf Premier Plus Plan (>400% FPL)
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- 中文
Summary of Benefits – Silver Leaf Premier Plus Plan (350 - 400% FPL)
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Summary of Benefits – Silver Leaf Premier Plus Plan (150 - 350% FPL)
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Summary of Benefits – Silver Leaf Premier Plus Plan (100 - 150% FPL)
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- English
- Español
- 中文
Summary of Benefits – Silver Leaf Premier Plan (>400% FPL)
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- English
- Español
- 中文
Summary of Benefits – Silver Leaf Premier Plan (350 - 400% FPL)
- View PDF:
- English
- Español
- 中文
Summary of Benefits – Silver Leaf Premier Plan (150 - 350% FPL)
- View PDF:
- English
- Español
- 中文
Summary of Benefits – Silver Leaf Premier Plan (100 - 150% FPL)
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- English
- Español
- 中文
Summary of Benefits – Silver Leaf Plan (>400% FPL)
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- English
- Español
- 中文
Summary of Benefits – Silver Leaf Plan (350 - 400% FPL)
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- English
- Español
- 中文
Summary of Benefits – Silver Leaf Plan (150 - 350% FPL)
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- English
- Español
- 中文
Summary of Benefits – Silver Leaf Plan (100 - 150% FPL)
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- English
- Español
- 中文
Leaf and Leaf Premier Plan Formulary
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- English
Leaf Premier Plan Formulary Changes
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- English
Leaf Plan Formulary Changes
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- English

Bronze

Member Handbook
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- 中文
- Русский
Summary of Benefits – Bronze Leaf Premier Plan
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- Español
- 中文
Summary of Benefits – Bronze Leaf Plan
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- English
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- 中文
Leaf and Leaf Premier Plan Formulary
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- English
Leaf Premier Plan Formulary Changes
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- English
Leaf Plan Formulary Changes
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- English

Green

Member Handbook
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- 中文
- Русский
Summary of Benefits – Green Leaf Plan
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- Español
- 中文
Leaf and Leaf Premier Plan Formulary
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- English
Leaf Plan Formulary Changes
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- English

Additional resources

Recommendations for Preventive Pediatric Health Care

What You Need to Know About HIV Testing
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- 中文

Individual & Family Plans Plan Documents

Looking for a form?

Medicaid Managed Care

Member Handbook

Member Handbook Insert - Updated Children's Home and Community Based Services

Member Handbook Insert – Changes to Service Authorization Timeframes

Medicaid Managed Care – Handbook Addendum

Covered Services

Pharmacy Benefit Change Alert

Pharmacy Benefit Change Alert – Members Who Have Medicare

Personal Wellness Plan

Member Handbook

Member Handbook Insert – Changes to Service Authorization Timeframes

Personal Wellness Plan – Handbook Addendum

Covered Services

Pharmacy Benefit Change Alert

Pharmacy Benefit Change Alert – Members Who Have Medicare

Child Health Plus

Member Handbook

Covered Services

Child Health Plus Formulary

Essential Plans

Member Handbook

Summary of Benefits – Essential Plan 1

Summary of Benefits – Essential Plan 2

Summary of Benefits – Essential Plan 3

Summary of Benefits – Essential Plan 4

Essential Plan Formulary

Essential Plan Formulary Changes

Marketplace Leaf & Leaf Premier Plans

Member Handbook

Summary of Benefits – Platinum Leaf Premier Plan

Summary of Benefits – Platinum Leaf Plan

Leaf and Leaf Premier Plan Formulary

Leaf Premier Plan Formulary Changes

Leaf Plan Formulary Changes

Member Handbook

Summary of Benefits – Gold Leaf Premier Plus Plan

Summary of Benefits – Gold Leaf Premier Plan

Summary of Benefits – Gold Leaf Plan

Leaf and Leaf Premier Plan Formulary

Leaf Premier Plan Formulary Changes

Leaf Plan Formulary Changes

Member Handbook

Summary of Benefits – Silver Leaf Premier Plus Plan (>400% FPL)

Summary of Benefits – Silver Leaf Premier Plus Plan (350 - 400% FPL)

Summary of Benefits – Silver Leaf Premier Plus Plan (150 - 350% FPL)

Summary of Benefits – Silver Leaf Premier Plus Plan (100 - 150% FPL)

Summary of Benefits – Silver Leaf Premier Plan (>400% FPL)

Summary of Benefits – Silver Leaf Premier Plan (350 - 400% FPL)

Summary of Benefits – Silver Leaf Premier Plan (150 - 350% FPL)

Summary of Benefits – Silver Leaf Premier Plan (100 - 150% FPL)

Summary of Benefits – Silver Leaf Plan (>400% FPL)

Summary of Benefits – Silver Leaf Plan (350 - 400% FPL)

Summary of Benefits – Silver Leaf Plan (150 - 350% FPL)

Summary of Benefits – Silver Leaf Plan (100 - 150% FPL)

Leaf and Leaf Premier Plan Formulary

Leaf Premier Plan Formulary Changes

Leaf Plan Formulary Changes

Member Handbook

Summary of Benefits – Bronze Leaf Premier Plan

Summary of Benefits – Bronze Leaf Plan

Leaf and Leaf Premier Plan Formulary

Leaf Premier Plan Formulary Changes

Leaf Plan Formulary Changes

Member Handbook

Summary of Benefits – Green Leaf Plan

Leaf and Leaf Premier Plan Formulary

Leaf Plan Formulary Changes

Additional resources

What You Need to Know About HIV Testing

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