You can change your Medicaid plan in NY at any time during the first 90 days after you enroll, then again after 12 months have passed. In between, you’re locked in unless you have a qualifying reason. The switch itself is a phone call to New York Medicaid Choice at 1-800-505-5678, and the new coverage begins the first of the following month.
When You’re Allowed to Switch
New York gives every managed care enrollee a 90-day free-look period. During those first 90 days you can move to any other plan available in your county for any reason at all, by calling your county’s Managed Care Unit or the New York Medicaid Choice Helpline.1Health.ny.gov. You Have 90 Days to Choose a Health Plan
After day 90, you’re locked into that plan for the next nine months. A switch during the lock-in requires what the state calls good cause. Once the full 12 months pass, the door reopens and you can change plans again without needing a reason.1Health.ny.gov. You Have 90 Days to Choose a Health Plan
Good-Cause Reasons During the Lock-In
The state recognizes several situations that justify a mid-lock-in change:
- You moved and your plan doesn’t serve your new area or can’t offer providers near your home.
- A doctor, specialist, or home care provider you rely on left the plan’s network.
- The plan failed to arrange services with appropriately licensed providers, hasn’t maintained or improved your health, or can’t give you adequate access to providers experienced in treating your condition.
- You were enrolled in the plan without your consent.
- You and the plan mutually agree a transfer would be in your best interest.
The state’s own enrollment guidance highlights moving out of a plan’s service area as a common example.1Health.ny.gov. You Have 90 Days to Choose a Health Plan The broader good-cause criteria come from the Department of Health’s managed long term care transfer policy, and the same principles apply across Medicaid managed care.2New York State Department of Health. MLTC Policy 21.04
How to Request the Change
By Phone
The fastest route is the New York Medicaid Choice Helpline at 1-800-505-5678. That line handles Medicaid managed care enrollment and plan changes, and staff can pick your new plan and process the switch on the same call.3New York State Department of Health. Medicaid Program Important Phone Numbers
For questions tied to your NY State of Health account, the Customer Service Center is at 1-855-355-5777, Monday through Friday 8 a.m. to 8 p.m. and Saturday 9 a.m. to 1 p.m.4NY State of Health. Reporting Changes
Online
If you manage your coverage through NY State of Health, log in at nystateofhealth.ny.gov to compare plans and request a change.5New York State of Health. Health Plan Marketplace for Individual and Small Business Health Insurance Some people prefer to narrow their choices online, then call to finish the switch.
In-Person Help
Navigators and certified enrollment assistors offer free one-on-one help in every county, speak more than 40 languages, and can meet with you evenings and weekends.6NY State of Health. Assistors You can find one through the Navigator Directory at info.nystateofhealth.ny.gov/NavigatorDirectory.7NY State of Health. Navigator Directory
If you enrolled through your local Department of Social Services or, in New York City, through the Human Resources Administration, you may need to contact that office to process the change. NYC residents can reach the HRA Medicaid Helpline at 1-888-692-6116.8NYC Human Resources Administration. Health Assistance – HRA
What to Check Before You Pick the New Plan
Not every plan operates in every county, and the differences between them can be bigger than they look on paper. Do a little homework before you call.
Your Providers
Confirm your doctors, specialists, and preferred hospitals are in the new plan’s network. The state’s Provider and Health Plan Look-Up lets you search by provider to see which plans include them, or by plan to browse the full network.9NYS Provider & Health Plan Look-Up. NYS Provider and Health Plan Look-Up This is where most people skip a step and regret it. Verify network status before you switch, not after your first appointment.
Your Prescriptions and Benefits
Each plan has its own formulary. If you take ongoing medications, check that they’re covered and whether they need prior authorization under the new plan. Extras vary too: transportation, over-the-counter allowances, wellness programs.
Dental and Vision
Most New York Medicaid managed care plans include dental and vision, but each plan contracts with its own dental vendor.10New York State Department of Health. Transition of Dental and Orthodontia Switching plans can mean switching dentists, so add that to your checklist.
When Your New Coverage Starts
Plan changes don’t take effect immediately. Your old plan keeps covering you through the end of the current month, and the new plan begins on the first of the next month. There is no gap on paper, but wait until your new ID card arrives before scheduling non-urgent visits under the new plan.
NY State of Health will send a confirmation notice with the effective date, and your new plan will mail an ID card and member handbook. If either is delayed, call the Medicaid Choice Helpline at 1-800-505-5678 or the NY State of Health Customer Service Center at 1-855-355-5777.3New York State Department of Health. Medicaid Program Important Phone Numbers
Keeping Treatment and Prescriptions Going
Switching in the middle of treatment is the part that worries most people, and the rules are built to smooth it out.
Ongoing Treatments
Your new plan is required to honor continuity of care for up to 90 days after enrollment.11New York State Department of Health. MLTC Policy 15.02 During that window the plan should keep covering services you were already receiving while it builds its own care plan for you. Bring documentation from your current providers so the transition doesn’t stall.
Prescription Medications
If a medication you take isn’t on the new plan’s formulary, the plan must provide a one-time temporary fill of up to a 30-day supply. That rule also covers formulary drugs that require prior authorization or step therapy under the new plan.12New York State Office of Mental Health. Medicaid Preferred Drug List and Managed Care Plan Information Use those 30 days to secure a prior authorization or line up a covered alternative. Don’t wait until day 29.
If Your Request Is Denied
If NY State of Health denies your switch, or your current plan takes an action you disagree with, you can appeal within 60 days of the date on the denial notice. Late appeals are still accepted if you submit a written explanation and the appeals unit finds good cause for the delay.13NY State of Health. Questions about Appeals
If the appeal is denied, you can request a state fair hearing. You have at least 120 days from the final adverse determination. If a plan misses its own response deadlines, you’re considered to have exhausted its process and can go straight to a fair hearing.14New York State Department of Health. New York State Medicaid Managed Care Enrollee Right to Fair Hearing and Aid Continuing for Plan Service Authorization Determinations
One detail catches people off guard. To keep your current services running while a denial is under appeal, request the fair hearing within 10 days of the plan’s final adverse determination. Miss that 10-day window and the plan can stop the disputed services while the hearing is pending.14New York State Department of Health. New York State Medicaid Managed Care Enrollee Right to Fair Hearing and Aid Continuing for Plan Service Authorization Determinations
When You Need a Different Kind of Plan Entirely
A standard managed care plan won’t cover long-term home and community-based services. If you or a family member needs that level of support for more than 120 days, you’d be transferring into a Managed Long Term Care plan, which is a separate enrollment track with its own assessment through the New York Independent Assessor Program at 855-222-8350.15New York State Department of Health. Managed Long Term Care (MLTC)16New York State Department of Health. New York Independent Assessor Program Frequently Asked Questions
A rising income is also different from a plan change. New York Medicaid covers adults with household income up to 138% of the federal poverty level.17U.S. Department of Health and Human Services. 2026 Poverty Guidelines If your income moves above that line, you aren’t picking a new Medicaid plan; you’re transitioning off Medicaid, often to the Essential Plan, which covers people up to 250% of the federal poverty level with very low or no premiums.18NY State of Health. Invitation and Requirements for Insurer Certification and Recertification for Participation in 2026 Report income changes promptly through your NY State of Health account or at 1-855-355-5777. Waiting can cost you coverage at renewal.