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What is the Healthfirst Personal Wellness Plan?

In 2015, the State of New York made some important changes to the Medicaid Managed Care program to offer better access to services and treatment for those with behavioral health needs. The Healthfirst Personal Wellness Plan is a result of this change.

The Healthfirst Personal Wellness Plan is for Medicaid Managed Care members who may benefit from extra behavioral health or substance abuse services. It offers all the same Medicaid Managed Care coverage and benefits, PLUS extra services like community support programs,* mental health treatment, substance abuse programs, and other behavioral health services to help you live life to the fullest.

Healthfirst Personal Wellness Plan members also have access to a dedicated care manager who will coordinate all services to meet each member’s personal wellness goals.

*Community support services start on 1/1/2016.
Who can enroll?
At this time, only Medicaid-enrolled individuals age 21 or older who have been identified by New York State as eligible to join a Health and Recovery Plan can enroll in our Personal Wellness Plan.
Will I have to change any of my doctors or other providers if I switch?
No. Medicaid Managed Care members don’t have to change their current doctors unless they want to.
What kind of Care Management does this plan offer?
Care coordination and management will be provided to all enrollees directly through Health Homes. In general, Health Homes will be expected to provide person-centered care planning, comprehensive care management, family support, and referrals. Plans will use member data to identify high-need individuals, notify Health Homes of any hospitalizations, and monitor Health Home performance. All enrollees will be referred to a Health Home and assigned a dedicated care manager within 15 days. After enrollment, the member’s care manager (or other qualified individual) will initiate a conflict-free, person-centered care planning process. This will include a brief evaluation of eligibility to receive 1915(i)-like services. Those deemed eligible will then receive an assessment to see which services should be provided. Reassessment of the Plan of Care must be done at least annually and when requested by the member.
Who helps decide which services I need?
Aside from the advice they already get from family, friends, and therapists, Personal Wellness Plan members can also get help making decisions about their care from a Health Home Care Manager. These professionals help members develop a Plan of Care, which may also include consulting a support network. All ideas and wishes will be considered important while creating the Plan of Care.
Do I have to be in a Health Home in order to enroll?
No. However, while there’s no requirement for a Healthfirst Personal Wellness Plan member to enroll in a Health Home, it’s still in their best interest to do so. That way, they can get access to a care manager in their community to help coordinate service delivery.
Will this plan cover traveling to non-medical appointments?
As long as it’s in the person’s Plan of Care, non-medical transportation for adults is covered. This includes non-routine trips that help members reach goals in their Plan of Care, such as finding a job. In such a case, the member can use non-medical transportation for traveling to/from their interview.
Will I need a new Healthfirst member ID card?
Yes. We’ll send one in the mail. Members will also get a package with more information about the Healthfirst Personal Wellness Plan shortly after that.
What if I have more questions?
We’re here to help! To learn more about the Healthfirst Personal Wellness Plan, you can call us at 1-855-659-5971 (TTY 1-888-542-3821), 24 hours a day, 7 days a week.
Do I need to sign up for the Healthfirst Personal Wellness Plan?

You do NOT need to sign up. If you are a Healthfirst Medicaid Managed Care member, the State of New York will let you know if you are eligible for the Healthfirst Personal Wellness Plan.

Once you are contacted, you will have 90 days to decide if you would like to take advantage of the Healthfirst Personal Wellness Plan.

  • • If you decide you would like to access the Healthfirst Personal Wellness Plan, you do not need to do anything. You will be enrolled automatically.
  • • If you decide that you do NOT want to access the Healthfirst Personal Wellness Plan, you can opt out by calling New York Medicaid Choice at 1-855-789-4277. You will continue to receive the same Medicaid Managed Care benefits you already have, without access to the extra services available through the Healthfirst Personal Wellness Plan.
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1-866-463-6743
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and Leaf Plans

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711
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1-866-585-9280

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TDD/TTY English
1-888-542-3821
TDD/TTY Español
1-888-867-4132
Current Medicare
Plan Members

1-888-260-1010
Monday - Sunday, 8am to 8pm

Become a Medicare
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1-877-237-1303
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TDD/TTY English
1-888-542-3821
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1-888-867-4132
Personal Wellness Plan
1-855-659-5971
TTY
1-888-542-3821
7 days a week, 24 hours a day
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