Who Does Not Have to Join a Health Plan

See a complete list of who does not have to join a plan or cannot join a plan.

Some Medicaid members cannot join a plan because of their medical needs or other reason. They are ‘excluded’. Others are not required to join a health plan but they can if they want to. They are ‘exempt’. If you have questions, call New York Medicaid Choice. Counselors will be glad to answer your questions. Call: 1-800-505-5678.  TTY: 1-888-329-1541.

Exemptions

You are not required to join a plan but you can if you want to.

  • American Indian/Alaskan Native
  • People in long-term alcohol or drug residential programs. (Please note: only residents of a Long Term Residential Substance Abuse Facility under Article 819 can apply for a Substance Abuse Exemption)
  • People who live in facilities for the developmentally disabled
  • People with regular Medicaid and being treated for a chronic medical condition for 6 months or  longer. They are seeing a regular Medicaid specialist who is not in a Medicaid health plan. (This exemption is limited to a 6 month period and for one time only)
  • People in waivered programs such as Care At Home and Traumatic Brain Injury (TBI)

Exclusions

You cannot join a plan because of your medical needs or other reason.

  • People in a hospice program at the time of enrollment.
  • Children or adults who live in state psychiatric or residential treatment facilities
  • People who will get Medicaid only after they spend some of their own money for medical needs (spend-down cases)
  • People with other full benefit health insurance
  • Infants living with their mothers in jail or prison
  • All foster care children in New York City
  • All foster care children living in an institutional setting outside of New York City   
  • Children who are blind or disabled and living apart from their parents for 30 days or more
  • People eligible for TB services only
  • People eligible for the Medicaid Cancer Treatment Program: Breast, Cervical, Colorectal and Prostate Cancer (MCTP)

Reach Us

1-800-505-5678

1-888-401-6582
(Long term care customer services)

TTY 1-888-329-1541

Monday - Friday
8:30 a.m. - 8:00 p.m.

Saturday
10:00 a.m. - 6:00 p.m.

Quick Assist

Have questions? We’re here to help. Our counselors will be glad to answer your questions. We can also help you choose a plan over the phone. All languages are spoken.