Not a Member ? I am a:

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

Applied Behavior Analysis (ABA) Services

Starting October 1, 2021, New York State Medicaid will cover Applied Behavior Analysis (ABA) therapy provided by:

  • Licensed Behavioral Analyst (LBA),

  • Certified Behavioral Analyst Assistant (CBAA) under the supervision of an LBA, or

  • Other individuals specified under Article 167 of NYS education law.

Who can get ABA?

Children/youth under the age of 21 with a diagnosis of autism spectrum disorder and/or Rett Syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). If you think you are eligible to get ABA services, talk to your provider about this service.

Note: You will need to use your Medicaid card when you receive these services.

The ABA services include:

  • assessment and treatment by a physician, licensed behavioral analysts, or certified behavior analyst assistants, or other qualified health professionals,

  • individual treatments delivered in the home or other setting, and

  • training and support to family and caregivers.

To learn more about these services, call Member Services at 1-888-320-9584.

Medication-Assisted Treatment (MAT) Formulary Change

The New York State Department of Health (NYSDOH) has created a new list of covered prescription drugs (also known as a formulary). This formulary will be used for the treatment of opioid dependence, and agents used to reverse an opioid overdose. The change will begin on October 1, 2021. Under the formulary, Medicaid Fee-For-Service and Medicaid Managed Care Members will follow a single formulary, where coverage parameters are consistent across the Medicaid Program. Certain preferred prescription drugs will also be available without a prior authorization.

What does this mean for CDPHP members?

  • Starting October 1, 2021, CDPHP® will cover buprenorphine/naloxone sublingual tablets, brand-name Suboxone films (buprenorphine/naloxone films), and buprenorphine sublingual tablets (to be used for induction only) without a prior authorization. Members currently on generic buprenorphine/naloxone film can continue to go to the pharmacy and the pharmacist is able to make the change to the brand drug.

  • Members who are currently on Zubsolv (buprenorphine/naloxone tablets) or buprenorphine sublingual tablets (as maintenance therapy) will need to get a new prescription from their provider. Letters will be sent to all impacted members and providers by September 3, 2021.

  • If a member or a provider determines that a change cannot be made at this time, a prior authorization request will be required to continue on non-preferred products. Prior authorization requests must include clinical documentation to support the use of the non-preferred product.

This table shows which drugs are preferred and non-preferred:

  Preferred Non-Preferred
Opioid Antagonists

Naloxone

Naltrexone

Narcan (nasal spray)

Opioid Dependence Agents – oral/transmucosal

Buprenorphine/naloxone

sublingual tablets

Suboxone

Buprenorphine for induction only

Bunavail

Zubsolv

Buprenorphine/naloxone film

Opioid Dependence Agents – Physician administered

Methadone (maintenance at a certified clinic)

Sublocade

Vivitrol

Probuphine

Voluntary Foster Care Agency (VFCA) Services

Starting July 1, CDPHP will cover Voluntary Foster Care Agency (VFCA) Health Facility services for those under the age of 21 who are eligible. These facilities work with children, youth, and families to promote well-being and positive outcomes for children placed in their care. These services include:

  • Core Limited Health-Related Services, such as skill building, nursing supports and medication management, Medicaid treatment and discharge planning, clinical consultation and supervision, and managed care liaison/administration.

  • Other Limited Health-Related Services, such as screening, diagnosis, and treatment services related to physical, developmental, and behavioral health, Children and Family Treatment and Support Services (CFTSS), and Children’s Home and Community Based Services (HCBS).

Also starting July 1, children and youth placed in foster care and a VFCA health facility, or children and youth placed in foster care in New York city, must join a Medicaid managed care plan. Children who are not eligible will receive services through regular Medicaid.

For more details, please review the CDPHP Medicaid or HARP handbooks.

To find out if you qualify for Medicaid, fill out this form and a CDPHP representative will contact you.