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Updated: Essential Plan Eligibility Expansion Effective April 1, 2024
3/29/2024 • Posted by Provider Relations

Beginning March 2, 2024, current enrollees in Qualified Health Plans (Ambetter from Fidelis Care) who are within 200-250% FPL were notified via letter from NY State of Health about the expansion of Essential Plan (EP) coverage in New York State. Members that now qualify for Essential Plan coverage will automatically be moved from their Qualified Health Plan to Essential Plan 200-250, effective April 1, 2024.

In addition to the Essential Plan Expansion, effective April 1, 2024, NYS will be implementing the EP Pregnancy Choice Provision.  Individuals who are currently in EP and who report being pregnant will remain EP eligible, instead of being moved into Medicaid. 

  • Members must report their pregnancy to NYSoH to update their enrollment.
  • Cost sharing for all services during pregnancy and for a 12-month post-partum period will be covered in full.

If a provider is already participating with Fidelis for Essential Plans, they will also be participating for the new Essential Plan 200-250. Additionally, since all EP levels are reimbursed on parity, or at the same rates, no contract amendments are required to implement these program enhancements.

Fidelis Care is prepared to support our members and providers throughout this transition and will communicate frequently with those affected. We are making every effort to ensure continuity of care by directly reaching out to high-risk patients, transferring prior authorization approvals, and providing coverage details through the Member and Provider Portals and fideliscare.org.

Resources for Members and Providers:

 

If you have any questions, please contact your Fidelis Care Provider Relations Specialist. To find your designated representative, please click here

 

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