Herkimer County

Managed Care

Table Of Contents:

Managed Care

Herkimer County currently has a mandated Medicaid Managed Care program through three Medicaid managed Care health plans. When a client joins a Medicaid Managed Care health plan, he/she uses the providers and hospitals that are in that plan. They choose their own doctor or nurse practitioner who will keep track of all their health care. This person is called Primary Care Provider (PCP). The PCP will refer the individual to a specialist when deemed necessary. Under Family Health Plus, all services are received from the selected managed care plan.

The Manged Care Unit provides enrollment/disenrollment into these Managed Care Plans for Medicaid and Family Health Plus eligible individuals. It also assists with billing issues.

Eligibility Criteria:

Serves Herkimer County residents eligible for Medicaid and Family Health Plus.

Referral Process:

Referral occurs during eligibility determination for Temporary Assistance, Medicaid and Family Health Plus. Plan marketers are on-site at the Department of Social Services.

Client Fees:

There are no co-pays when a recipient is in a Medicaid Managed Care health plan. The client will receive his/her own health plan card that is separate from the Common Benefit Identification Card (CBIC).

Managed Care

Q. What are the three Medicaid Managed Care Health Plans and how can they be reached?

  • Fidelis Care NY - 1-888-343-3547
  • United Health Care of Upstate NY - 1-800-396-7179
  • Excellus HMO Blue Option - 1-800-919-8809


Q. How does a client choose a health plan?
A. In choosing a health plan, the recipient should think about the doctors he/she wants, the services he/she and his/her family need, and the health plans available. It is important that they make sure the doctor they want to see is in the health plan they choose. After a plan is chosen, the client must use the hospital, clinics and doctors that work with that plan.