Medicaid and Medicaid HARP

The following updates have been made to your CDPHP Medicaid plan:

Note: Effective April 1, 2026, this notification replaces the information that is currently in the CDPHP member handbook

Children's Home and Community Based Services

New York State covers Children's Home and Community Based Services (HCBS) under the children's waiver. CDPHP covers children's HCBS for members participating in the children's waiver and provides care management for these services.

Children's HCBS offer personal, flexible services to meet the needs of each child/youth. HCBS are provided where children/youth and families are most comfortable and supports them as they work towards goals and achievements.

Who can get Children's HCBS?

Children's HCBS are for children and youth who:

• Need extra care and support to remain at home/in the community

• Have complex health, developmental and/or behavioral health needs

• Want to avoid going to the hospital or a long-term care facility

• Are eligible for HCBS and participate in the children's waiver

Members under age 21 will be able to get these services from their health plan:

• Community habilitation

• Caregiver/ Family Advocacy and Support Services

• Prevocational services - must be age 14 and older

• Supported employment - must be age 14 and older

• Respite services (planned respite and crisis respite)

• Palliative Care

  • Expressive Therapy

  • Massage Therapy

  • Bereavement Service

  • Pain and Symptom Management

• Non-medical Transportation

Members under age 21 will access the following services through designated health homes using your Medicaid card:

• Environmental Modifications

• Vehicle Modifications

• Adaptive and Assistive Technology

• Transitional Care Coordination

• Transitional Services

Children/youth participating in the Children's Waiver must receive care management. Care management provides a person who can help you find and get the services that are right for you.

• If you are getting care management from a Health Home Care Management Agency (CMA), you can stay with your CMA. CDPHP will work with your CMA to help you get the services you need.

• If you are getting care management from the State operated Children and Youth Evaluation Service (C-YES), CDPHP will work with the State operated C-YES and provide your care management.

Chronic Disease Self-Management Program (CDSMP) for Arthritis

If you’ve been diagnosed with arthritis and are interested in learning more about self-management related to this disease, Capital District Physicians’ Health Plan, Inc. (CDPHP^®) covers services that may help.

Starting June 1, 2025, Capital District Physicians’ Health Plan, Inc. (CDPHP^®) will cover the Chronic Disease Self-Management Program (CDSMP) for adults aged 18 years and older, which aims to increase confidence, physical and mental well-being, and knowledge to manage long term conditions.

This program may help prevent you from:

• going to the emergency room;

• being admitted into the hospital; and/or

• needing other medical care for your arthritis.

Each CDSMP series meets 2.5 hours once per week, for a total of six weeks.

Eligibility

You may be eligible for CDSMP for arthritis services if you have a recommendation by a physician, or other licensed practitioner, and are:

• At least 18 years old; and

• Diagnosed with arthritis.

Talk to your provider to see if you qualify to take part in the CDSMP for arthritis.

To learn more about these services, please call Member Services at
1-800-388-2994. TDD/TTY: 711.

Social Care Network Benefit

Starting January 1, 2025, you can receive screening and referral to existing local, state and federal services through regional Social Care Networks (SCNs). If you are eligible, these local groups can connect you to services in your community that help with housing, food, transportation, education, employment, and care management at no cost to you.

• After screening through the SCN, you and any interested member(s) in your household can meet with a Social Care Navigator who can confirm eligibility for services that can help with individual health and well-being. They may ask you or members in your household for supporting documentation to determine where extra support may be needed.

• If you or any member(s) in your household qualify for services, the Social Care Navigator can work with you to get the support needed. You may qualify for more than one service, depending on individual eligibility. These services include:

  • Housing and utilities support:

    • Installing home modifications like ramps, handrails, grab bars, pathways, electric door openers, widening of doorways, door and cabinet handles, bathroom facilities, kitchen cabinet or sinks, and non-skid surfaces to make your home accessible and safe.

    • Mold, pest remediation, and asthma remediation services.

    • Providing an air conditioner, heater, humidifier, or dehumidifier to help improve ventilation in your home.

    • Providing small refrigeration units needed for medical treatment.

    • Medical Respite.

    • Helping you find and apply for safe and stable housing in the community which may include assistance with rent and utilities.

  • Nutrition support:

    • Getting help from a nutrition expert who will help you choose healthy foods to meet your health needs and goals.

    • Getting prepared meals, medically tailored meals, food prescriptions, fresh produce, or non-perishable grocery items.

    • Providing cooking supplies like pots, pans, utensils, a microwave, and a refrigerator to prepare meals.

  • Transportation services:

    • Helping you with access to public or private transportation to places approved by the SCN such as going to a job interview, parenting classes, housing court to prevent eviction, local farmers’ markets, and city or state department offices to obtain important documents.

  • Care management services:

    • Getting help with finding a job or job training program, applying for public benefits, managing your finances, and more.

    • Getting connected to services like childcare, counseling, crisis intervention, health homes program, and more.

Getting in Contact with an SCN in your area:

1. You may call the health plan’s member services 1-800-388-2994 (TDD/TTY: 711) and we will connect you to the SCN in your area.

2. You may call the SCN serving your county and request a screening or more information. See the SCN contact information in the chart below.

3. You may also visit their website to begin a self-screening.

Once connected with the SCN, a Social Care Navigator will confirm your eligibility by asking questions, requesting supporting documentation (if necessary), tell you more about eligible services, and help you get connected to them.