10/27/2025
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Posted by Provider Relations
NY State of Health has announced upcoming changes to the Essential Plan 5, effective July 1, 2026. To help current enrollees prepare, Fidelis Care members have started receiving official notifications from the state outlining these updates.
To support you in addressing patient questions, Fidelis Care has compiled a list of frequently asked questions (FAQs) to guide your conversations and provide clarity.
FAQs
I have patients saying they received a letter about their Essential Plan coverage ending. What is going on?
- Essential Plan 5 members recently received a letter from NY State of Health notifying them that EP5 will end on July 1, 2026. According to NY State of Health, this change is due to anticipated changes in federal funding that will make support of EP5 not feasible.
- Your patients’ coverage remains the same at this time. We will work with these patients as we get closer to July 2026 to find different coverage options once we are provided more information by New York State.
What should I tell my patients who receive the letter?
- Please let your patients know there is no change to their coverage right now. However, their EP5 coverage is currently scheduled to end on July 1, 2026.
- Remind your patients with EP5 coverage to update their NY State of Health accounts to reflect changes in income, household size, and contact information.
- NY State of Health and Fidelis Care will provide more information about the change in the coming months.
- If your patients have questions, please have them call Fidelis Care at 1-888-FIDELIS (1-888-343-3547). Fidelis Care members can also visit one of our Community Offices or StreetSide vehicles for assistance.
What about patients in Essential Plans 1-4?
- The change affects only EP5 members (200–250% FPL). EP1–EP4 members are not impacted.
For additional questions, or if we can be of assistance in any way, please contact your Fidelis Care Provider Engagement Account Manager. To identify your designated representative, please visit Contact Your Designated Provider Relations Specialist.
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