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Medicaid

Who can join the program?
How much does membership cost?
What services are covered?

Who can join our Medicaid managed care program? People who...

are eligible for Medicaid in either the TANF, Transitional Medical Assistance or SSI programs;
live in New York City, or in Nassau, Orange, Rockland, Suffolk or Westchester county;
are not on Medicare;
are not living in a Residential Health Care Facility (RHCF), a nursing home, a family care home licensed by the NYS Office of Mental Health, a State-operated psychiatric facility, or a residential treatment facility for children and youth;
are not in foster care;
are not in a Long Term Home Health Care program or Child Care Facility;
are not in a hospice program at the time of enrollment.

How much does Medicaid managed care program Membership cost?

This program is free...the government...not the Member ...pays Affinity Health Plan. Members do not have to pay a monthly premium; also, there are no deductibles or co-payments for covered services.

What services does our Medicaid managed care program cover?

Affinity covers almost all of the services offered under the New York State Medicaid program. Medicaid services that are not covered by Affinity are available to our Members directly from the State.

Service	Covered by Affinity	Covered by New York State
Physician services: primary care, specialty care including surgery	X
Inpatient hospital care: medical, surgical, obstetrical	X
Inpatient hospital care: mental health and substance abuse	X (except SSI)	X (for SSI)
Maternity care: pre-natal, deliveries, post-partum	X
Emergency room visits	X
Family planning services	X
Dental care	X
Eye care, including glasses	X
Mental health visits	X
Alcohol and drug abuse visits		X
X-rays, lab tests and other diagnostic services	X
Emergency transportation	X (except Orange County)	X (in Orange County)
Non-emergency transportation	X (except Orange and Rockland Counties)	X (in Orange and Rockland Counties)
Hearing services, including hearing aids	X
Occupational, physical and speech therapy	X
Home health visits	X
Pharmacy (prescription and non-prescription drugs and supplies)		X
Podiatry for medical conditions	X
Durable medical equipment	X

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