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HomeProvidersProvider ResourcesEducational MaterialsMember Renewal Questions

Addressing Key Member Questions Concerning Redetermination in New York

Can you provide more information on redetermination / renewal process?
  • Redetermination/renewal is the annual process, required by New York State, for most Medicaid, HARP, MLTC, EP, and CHP members to go through to maintain health insurance coverage. It has been paused since March 2020 due to the COVID public health emergency (PHE). 
  • NYS requires documentation around areas like income and household size to determine eligibility each year.
I haven’t renewed my coverage in a few years, does that mean I no longer need do renew each year?
  • No, you will have to renew your insurance again. Due to requirements in federal law and other flexibilities, NY State of Health has kept you enrolled in Medicaid, Child Health Plus, or the Essential Plan without requiring you to renew your insurance every year. 
  • However, federal law has changed and regular renewal processes will resume over the course of a year, beginning in Spring 2023. NY State of Health will notify you via email, text, and/or mail when it’s time for you to renew each year.
How will members know when they need to renew or if they need to provide information?
  • New York State will notify members based on their contact preference. 
    • For paperless renewals, members will receive an email alert when NYSOH posts new notices to their online account. 
    • For printed renewals, notices will be mailed via US Postal Service from the HRA in NYC or local DSS.
  • If members need to provide information, the notification will provide instructions on next steps. 
  • If members do not need to provide information, the notification willalert them that their renewal is complete.
  • Fidelis Care will also provide communications via email and phoneoutreach. Members should also log in to their Fidelis Care member portal forinformation and guidance on next steps.
  • When connecting with us over the phone or in person at community officesor events, Fidelis Care can also look up the member’s recertification (renewal)date, and tell them when they will need to take action.
  • Based on the member’s renewal date, they can expect to receivecommunications about taking action to renew approximately 60 days before thisdate.
  • Fidelis Care can provide assistance at any point in the renewal processand answer any questions they may have. 
How can members be sure they receive the notification for renewing?
  • It’s important for members to keep their contact information updated with NY State of Health.
  • It’s also important for members to provide Fidelis Care with their most current information, including email address, so that we can send reminders related to any action they need to take. They can also give us their consent for text messaging in the future.
  • Members can also confirm the information we have on file for them.
What if members forget to provide the needed information and lose coverage?
  • If a member does not take action to renew insurance for themselves or their family members by the deadline given, they are at risk of losing their health insurance coverage.
  • Depending on how much time has passed, they can likely provide the information to NY State to regain their health insurance coverage if the state determines they are still eligible.
  • If members miss a deadline, or lose coverage, Fidelis Care also can help. They can reach our Member Retention team at 1-866-435-9521. They can also stop by one of our Community Offices or visit an RV location. More information regarding Community Offices and RV locations is available on our website at: fideliscare.org/offices.
  • Members can also fill out our contact form at fideliscare.org/renew-helpif they would like us to call them directly.
How do members update their contact information with the State?
  • Members can update their contact information with NY State of Health (NYSOH) by calling 1-855-355-5777 Monday through Friday from 8 AM to 8 PM and Saturday from 9 AM to 1 PM. They can also update their contact information by logging into their NYSOH account at www.nystateofhealth.ny.gov.
What do members with D-SNPs need to do to renew Medicaid coverage?
  • The State will send a notification in the mail regarding redetermination and next steps.
  • If they need to provide information, the notification will provide instructions on next steps.
  • If they do not need to provide information, the notification will alert them that their renewal is complete. 
What steps do Fidelis Care at Home (MLTC) members need to take?
  • Fidelis Care’s Retention and Member Services teams can help them with information related to their renewal date, and the timelines for renewing their coverage. Our Member Retention team can be contacted at 1-866-435-9521, and our Member Services team can be reached at 1-888-FIDELIS (1-888-343-3547); TTY: 711 
  • Members can also speak with their Care Manager.
For members turning 65 (or have turned 65), what other options do they have?
  • Fidelis Care offers WellCare by Fidelis Care Medicare Advantage and Dual Advantage plans. We can direct their call to that team for more information or provide a web URL for more information. 
  • We can connect them with that team, or they can call: (800) 288-5441.
What if members don’t think they can afford Marketplace coverage?
  • The cost of a Marketplace (QHP) plan depends on many factors, including household income and household size.
  • There are plans that are very low cost, or even that have a $0 premium.
How do members find out about Fidelis Care Marketplace plans and how much they would cost?
  • We have a team that can assist. Our Representatives can explain the plans, provide a quote for members and their family, and even help them enroll through NY State of Health.
  • They may be eligible for savings and cost share reductions for a Marketplace plan. We have a team that can help them determine that.

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How You Can Help

  • Patients in Medicaid Managed Care, Essential Plan, Child Health Plus, or HARP plans with a coverage end date of June 30, 2023 will need to renew their health insurance through the NY State of Health Marketplace, their Local Department of Social Services, or NYC’s Human Resources Administration.
  • Check your patient’s renewal (recert) date by going to Fidelis Care’s Provider Portal and accessing the patient details. If the renewal date is within the next 90 days, please remind your patient that they will need to renew their coverage. You can share the renewal information, located below, with your patient.

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Renewal Information for Your Patients

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Call Fidelis Care at 1-866-435-9521; TTY: 711.

➥ Monday-Friday from 8:30 AM-6 PM.

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Fill out our contact form at fideliscare.org/renew-help. 

➥ A Fidelis Care Representative will call you to help with renewing your coverage.

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Visit a Fidelis Care Community Office or StreetSide RV for in-person help. 

➥ View locations at fideliscare.org/offices.

If a member enrolled their health insurance through NY State of Health, they can also renew directly online.

Or, by calling NY State of Health at 1-855-355-5777; TTY: 1-800-662-1220.

➥ Monday-Friday from 8 AM-8 PM or Saturday from 9 AM-1 PM.

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Provider Talking Points for NY Health Insurance Renewals

How can I assist my patients in understanding when they need to renew their coverage?
  • Examine if (and where in) your eligibility verification procedures include coverage end date information.Fidelis Care transmits coverage end dates in x12 271 files responding to 270 eligibility inquiry transactions and this information may appear in a variety of formats depending on the clearinghouse or software interface being used by providers. Most members need to take action starting 45 days from their coverage end date, with the deadline typically 15 days before coverage ending. 
  • Routinely download your provider roster on the Fidelis Care Provider Portal – this roster contains the ‘recert date’ indicating when members can begin to take action to renew their coverage. It can also be helpful for you and your patients to understand when their coverage end date is if no action is taken.
  • Distribute education materials from NYS and Fidelis about the renewal requirements in your office and encourage members to get in touch with us for assistance.


What does the ‘Recert Date’ field on my provider portal roster mean?
  • The ‘recert date’ field published on the provider rosters of active members is the first date that the member can take action to complete their renewal application on the New York State of Health Marketplace. It is typically 45 days before their coverage end date.The deadline for members to take action to maintain coverage without a lapse is 15 days prior to their coverage end date. It can also be helpful for you and your patients to understand when their coverage end date is if no action is taken.
    • For example, a Member has coverage active through June 30, 2023 with eligibility through the New York State of Health marketplace.The first date of action, also known as the recertification date is May 16, 2023.The deadline for the member to take action without a risk of coverage lapsing is June 15, 2023. 
What is the process to recertify and what are the different methods?
  • Redetermination/renewal is the annual process, required by New York State, for most Medicaid, HARP, MLTC, EP, and CHP members to go through to maintain health insurance coverage. It has been paused since March 2020 due to the COVID public health emergency (PHE).
  • NYS requires documentation around areas like income and household size to determine eligibility each year- either through an electronic process for those with eligibility on the New York State of Health website, or through a paper process for those with eligibility through their county LDSS or HRA in NYC.
  • New York State will notify members based on their contact preference. For paperless renewals, members will receive an email alert when NYSOH posts new notices to their online account. For printed renewals, notices will be mailed via US Postal Service from the HRA in NYC or local DSS.
  • If members need to provide information, the notification will provide instructions on next steps.
  • If members do not need to provide information, the notification will alert them that their renewal is complete.
  • Fidelis Care will also provide communications via email and phone outreach. Members should also log in to their Fidelis Care member portal for information and guidance on next steps.
  • When connecting with us over the phone or in person at community offices or events, Fidelis Care can also look up the member’s recertification (renewal) date, and tell them when they will need to take action.
  • Based on the member’s renewal date, they can expect to receive communications about taking action to renew approximately 60 days before this date.
  • Fidelis Care can provide assistance at any point in the renewal process and answer any questions they may have.