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Enhanced (HARP) Plan

MetroPlusHealth Enhanced is a Health and Recovery Plan (HARP) qualified by New York State and has specialized expertise, tools and protocols that are not part of most medical plans.

MetroPlusHealth Enhanced (HARP) is a plan that manages the physical health, mental health, and substance use services in an integrated way for adults requiring specialized protocols and expertise not found within most medical plans. This plan does not require you to change your current health care providers.

Who is eligible?

Adult Medicaid and HIV Special Needs Plan (SNP) enrollees who are 21 or older with serious mental health conditions (mental illness and/or substance use disorders) are eligible to receive covered benefits.

Eligible individuals will be identified by the State if they are qualified to enroll giving them the opportunity to join a MetroPlusHealth Enhanced plan.

People who are eligible will get a letter in the mail informing of their eligibility and giving them the opportunity to opt out.

HARP enrollees will receive access to Medicaid, behavioral health, and an additional package of Home and Community Based Services (HCBS).

We use Health Homes to coordinate services for our members. If you choose to join a Health Home, MetroPlus can help you enroll in a Health Home that will assign you a personal Health Home Care Manager. Your Health Home Care Manager can help you make appointments, help you get social services, and keep track of your progress.

Your Health Home is responsible for giving you an assessment to see what Behavioral Health Home and Community Based Services you may need. Using the assessment, you and your Health Home Care Manager will work together to make a Plan of Care that is designed especially for you.

 

Speak to MetroPlusHealth

Questions? Ready to sign-up?

Our Member Services team is always here to help. We are here Monday through Saturday from 8:00AM to 8:00PM. Just call 1.800.303.9626 (TTY:711).

Our 24/7 Customer Service Hotline will answer your call at other times and on holidays.

Medicare members can call us 24/7 at 1.866.986.0356 (TTY: 711).

If you are experiencing a mental health crisis, our Behavioral Health Crisis after hours partner — Vibrant Emotional Health — can be reached 24/7 at 1.866.728.1885 (SMS capable for the hearing impaired).

Rx Carveout

Beginning April 1, 2023, all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.

Information about the transition of the pharmacy benefit from MetroPlusHealth to NYRx, the Medicaid Pharmacy Program can be found here.

General information about NYRx, the Medicaid Pharmacy Program can be found here along with information for Members and Providers.

 

Important Message To Our Members Regarding CORE Services

Effective February 1, 2022, in order to improve access to services, NYS is transitioning four BH HCBS to a new service array called Community Oriented Recovery and Empowerment (CORE) Services. These four services include Community Psychiatric Support and Treatment (CPST), Psychosocial Rehabilitation (PSR), Family Support and Training (FST), and Empowerment Services – Peer Support (Peer Support). BH HCBS Short-term and Intensive Crisis Respite services will be transitioned to Crisis Intervention Benefit Crisis Residence services, already available to all adult Medicaid Managed Care enrollees. All other existing BH HCBS will remain available as BH HCBS with previously established requirements, workflows, and processes.

CORE services are specialty services that can help people meet their recovery goals, like getting help with finding a job or going to school, or living more independently.

For members who are 21 or older, covered by Medicaid, and enrolled in a Health and Recovery Program Enhanced (HARP), CORE services may be just right. Additionally, some individuals enrolled in HIV-Special Needs Plans or Medicaid Advantage Plus Plans will be eligible for CORE. CORE services are covered by health insurance, at no cost to our members.

You do not need the New York State Eligibility Assessment to get Community Oriented Recovery and Empowerment (CORE) Services. You can get a CORE service if it is recommended for you by a Licensed Practitioner of the Healing Arts (LPHA). 

Learn more about CORE services below. Questions about CORE services? Call us at 1.800.303.9626 or speak with your behavioral health provider.

CORE Member Brochure

Plan Benefits

In addition to managing all of your current Medicaid and Behavioral Health and CORE Services, the Enhanced (HARP) also covers Home and Community Based Services (BH HCBS). BH HCBS provide opportunities for Medicaid recipients with behavioral health conditions to receive specialized support services in their home or community.

Health Home Care Managers help you make appointments with your providers, stay on top of your medications and coordinate care across all of your treating clinicians. They also assess need for Behavioral Health Home and Community Based Services (BH HCBS). Working with your Health Home care managers, you will be given the opportunity to complete an assessment to determine which Home and Community Based services you are eligible to receive.

List of covered BH HCBS services:

  • Rehabilitation: Rehabilitation services are designed to restore an individual’s functional level to the highest degree possible and to facilitate integration into the community.
  • Crisis Intervention Benefit Transition: Effective February 1, 2022, BH HCBS Short-term and Intensive Crisis Respite services transitioned to Crisis Intervention Benefit Crisis Residence services, available to all Adult Medicaid Managed Care members

Effective February 1, 2022, BH HCBS services covered in Enhanced (HARP) include:

  • Habilitation: Habilitation services, which are typically provided on an individual basis, are designed to assist members in improving skills such as communications, activities of daily living, socialization, and use of community resources.
  • Education Support Services
  • Pre-vocational services that prepare individuals for employment.
  • Transitional employment services are available to strengthen an individual’s work record and work skills.
  • Intensive Supported Employment
  • Ongoing Supported Employment
  • Non-Medical Transportation: Non-Medical Transportation services are offered to members to access transportation to destinations that are related to achieving recovery such as a job interview, a college fair, a wellness seminar, or other relevant activities.
  • Peer Supports: Peer Support services are delivered by peers with a recovery focus and promote skills for coping with one’s behavioral health condition(s).
  • Educational Support Services: Educational Support Services are designed to assist individuals who want to start or return to school or formal training with a goal of achieving skills necessary to obtain employment. MetroPlusHealth’s Enhanced (HARP) is designed to provide person-centered recovery services that emphasizes and supports an individual’s potential for rehabilitation by maximizing quality of life and reducing symptoms of behavioral health conditions. Through empowerment, choice, treatment and education MetroPlusHealth’s Enhanced (HARP) promotes recovery, health and well-being.

IMPORTANT NOTICE FOR OUR ENHANCED (HARP) MEMBERS AGED 21 YEARS AND OLDER

MetroPlusHeath is proud to offer benefits and services that help you live a healthy life. Starting July 1, 2022, you can join a no-cost Medically Tailored Meals program that provides healthy meals straight to your home.

Through this program, you and other members who qualify can get:

  • Help from a registered dietitian and nutritionist. This person is a food and nutrition expert and will help give guidance and support in choosing healthy foods.

Up to three meals per day delivered to your home for six months at a time. You may be able to continue receiving meals as long as you are eligible for this program. These meals are tailored for your specific health needs and can help you gain access to healthy, nutritious foods. Learn more about this program below.

Important notice about your Enhanced (HARP) managed care plan benefits.

Starting January 1, 2023, MetroPlusHealth will cover Gambling Disorder Treatment provided by Office of Addiction Services and Supports (OASAS) certified programs.

You can get Gambling Disorder Treatment:

  • face-to-face; or
  • through telehealth.

Learn more below, in the Plan Materials section.

Important Notice: Effective October 1, 2021, our members now access their behavioral health services through MetroPlusHealth. Learn more here.

Questions?

Our Member Services team is always here to help. We are here Monday through Saturday from 8:00AM to 8:00PM. Just call 1.800.303.9626 (TTY:711).

Our 24/7 Customer Service Hotline will answer your call at other times and on holidays.

Medicare members can call us 24/7 at 1.866.986.0356 (TTY: 711).

If you are experiencing a mental health crisis, our Behavioral Health Crisis after hours partner — Vibrant Emotional Health — can be reached 24/7 at 1.866.728.1885 (SMS capable for the hearing impaired).

If you would like a hard copy of this handbook, you can submit a request online here or call us at 1.800.303.9626 (TTY: 711). Please be sure to tell us which plan handbook – for example, Enhanced (HARP) – you need.

Did you know?

If you are turning 65 within the next 3 months or you are 65 years of age or older, you may be entitled to additional medical benefits through the Medicare program. Learn more here. If you have questions, please call Customer Services team at 1-800-303-9626. If you have Medicaid, you MUST apply for Medicare as a condition of continuing eligibility.

You can apply for Medicare by calling the Social Security Administration at 1-800-772-1213 or by applying on-line at: https://www.ssa.gov/medicare/. You may be required to submit proof that you have applied for Medicare so please keep your award or denial letter from SSA or your on line receipt from SSA.

If you have more questions, please call our Customer Services team at 1-800-303-9626.

Important Update

Pharmacy Network Change

Starting January 1, 2022, Walgreens and Duane Reade will no longer be in the pharmacy network for members of these plans:

  • Medicaid Managed Care (including Partnership in Care and HARP Plans)
  • Child Health Plus
  • Exchange / MarketPlace Plans

Where can I find a list of participating network pharmacies?

Members can find a list of network pharmacies or use our online provider search tool.

What do I do if I get my medications from Walgreens or Duane Reade?

Members who have an ongoing prescription including medications, certain supplies such as pen needles, test strips, continuous glucose monitors, and blood glucose test strips at a Walgreens or Duane Reade should call their health care providers to get a new prescription to be sent to a different pharmacy.

Who can I call if I have questions?

If you have any questions, please call the CVS Caremark® Customer Care Team at 1-(855) 656-0361 for Medicaid Managed Care and Child Health Plus members or 1-(855) 383-9426 for Exchange Plan members.

View over a man's shoulder of the phone he is holding and the table he is sitting at with a computer, notebook, and coffee
MetroPlusHealth Virtual Visit

Access to your doctor—whenever and wherever you need it!

MetroPlusHealth Virtual Visit is the fast, easy way for our members to see a provider for common physical, mental, emotional, and behavioral health issues that are not emergencies. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 – and in your language.

GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.

Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.

Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.

Know your rights and protections against surprise medical bills!

When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.

Are you receiving care at an NYC Health + Hospitals facility?

Manage Your Health Online With MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:

  • Message your primary care provider’s office
  • Request refills of your prescription drugs
  • Access your test results
  • Schedule appointments
Preventive Services Resources

Learn about all of the free preventive services for adults, women and children. Preventive care includes immunizations, physical exams, lab tests and prescriptions. If you have any questions, call one of our Member Services Representatives. We’re here to help.

Health Risk Assessment 

HRA can be returned to:
ATTENTION: QM Health Risk Assessment Unit
MetroPlus Health Plan
50 Water Street, 7th Floor
​New York, NY 10004
or by completing our Contact form by clicking here.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

Monkeypox cases are rising in NYC. Learn more about Monkeypox, including prevention and treatment, here.

last updated: August 11, 2022

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