Medicaid, Child Health Plus, and Essential Plan: What You Need to Know to Renew

If you have Medicaid, Child Health Plus, or Essential Plan, you may need to renew it each year to keep your coverage. We’re here to help.

Every year, people who have Medicaid, Child Health Plus, and the Essential Plan have to renew their coverage. You may not qualify for the same coverage you have now.

Medicaid Plans
Medicaid offers comprehensive coverage with no monthly premium for both children and adults.

Medicaid covers regular health exams, immunizations, doctor and clinic visits, many medical supplies and equipment, lab tests and X-rays, emergencies, and prescriptions. It also covers vision and dental care, nursing home stays, and hospital stays. There is a small copay for some services.

Essential Plan
Is your income higher than the Medicaid level? You may still be eligible for a $0 premium health insurance through the Essential Plan. These plans have no deductible and no copays for preventive care.

Essential Plans cover routine doctor visits with your primary care doctor or specialists, tests ordered by your doctor, prescriptions, hospital stays, and more. They also provide vision and dental coverage. There may be a copay for some services.

Here are the current income guidelines for Essential Plans, from NY State of Health:

Household Size	Most Household Can Make Per Year
1	$37,650
2	$51,100
3	$64,550
4	$78,000
5	$91,450
6	$104,900

Child Health Plus
If you have a child under age 19 who does not have health insurance, they may still qualify for Child Health Plus.

Child Health Plus covers well-child visits and physical exams, immunizations, prescriptions, and over-the-counter drugs when ordered by a licensed provider, tests and imaging, and emergency care. It also covers hospital stays and surgeries, outpatient therapy, and mental health care. Vision and dental care, speech and hearing care, and limited physical and occupational therapy benefits are all included.

Here are the current income guidelines for Child Health Plus this year, from the NY State of Health:

Qualified Health Plans
Did your income increase since 2020? Have you lost eligibility for the plans above? You still qualify for health insurance under a Qualified Health Plan (QHP). Depending on your income, you may even qualify for tax relief that can reduce your monthly health insurance premiums – to as low as $0 for some plans!

All QHP plans are required to cover these 10 essential benefits, although many plans cover additional services:

1. Routine doctor visits and outpatient care
2. Emergency services
3. Hospital stays
4. Birth control, pregnancy, maternity, and newborn care
5. Mental health and substance use disorder services
6. Prescription drugs
7. Physical and occupational rehabilitation services and devices
8. Diagnostic testing
9. Preventive and wellness services and chronic disease management
10. Pediatric care, including vision and dental services

How to Renew
You will receive a renewal notice from NY State of Health that tells you when it’s time to renew and what you need to do. If you enrolled in Medicaid through your local county office, you will receive a renewal packet from your Local Departments of Social Services.

Did your family or income information change? Be prepared to share your:
● Identification details
● Household income
● Family size

If you think you should have received a letter, or if you have questions about your renewal, please reach out to us. We can help make sure you don’t lose coverage.

Speak with a CDPHP Renewal Specialist
Our specialists are trained to help you with Medicaid, Child Health Plus, Essential Plan and Qualified Health Plan renewals. They can also help you choose a new plan if you no longer qualify for the plan you have now.

Call 1-866-MyCDPHP (1-866-692-3747) or email stateprograms@cdphp.com
Please use this email solely for scheduling appointments and avoid sending any personally identifiable or protected health information.
You can also find more plan options at plans.cdphp.com.

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