HomeFirst FAQ

Yes, HomeFirst has an extensive network of providers. Our Member Services will make every effort to identify a personal care worker who can speak your language.

Yes, HomeFirst employees speak multiple languages. We can also accommodate members with Language Line telephone interpreter services.

HomeFirst has member materials written in the most prevalent languages of our enrollees. If interpretation or translation is required, please feel free to call Member Services at toll-free at 1-877-771-1119 and request to speak to an interpreter or ask for written materials in your language. For TTY, call 711.

Hearing-impaired members with TTY/ TDD ability who wish to speak with a Member Services Representative should first contact a relay operator at 711. They will then facilitate calls between TTY/TDD users and voice customers.

HomeFirst also has materials like member handbooks in Braille, CDs, or audio tapes available upon request for visually impaired members. Please contact Member Services to request a copy. Should you need the handbook or any other HomeFirst documents and forms read to you, HomeFirst will arrange an appointment for this service at your convenience.

If you need to adjust your home care schedule, please contact our HomeFirst Member Services department toll-free at 1-877-771-1119, Monday through Friday from 8:30 a.m. to 5:00 p.m. For TTY, call 711. Qualified clinical personnel will determine if a service is medically necessary and appropriate based on a comprehensive assessment of your current condition. We will make a decision regarding your request within 14 days of receiving it.

If you are in the hospital, be sure to ask your physician or hospital discharge planner to contact HomeFirst. HomeFirst will work with you, your physician and the hospital discharge planner to arrange for your care upon discharge.

Yes, routine (non-emergency) medical transportation is a benefit offered to HomeFirst members. The transportation service is provided directly by Medicaid through Medical Answering Services (MAS). You will need to call MAS directly at 1-844-666-6270 if you reside in the 5 boroughs of NYC, Nassau, Westchester, or Putnam, or 1-866-932-7740 for Dutchess, Orange, Rockland, Sullivan, and Ulster counties. There is no cost for this service, and no restrictions on the number of rides available to you as long as they are to and from medical appointments.

For vision benefits inquiries, please call Superior Vision at 1-844-353-2902 Monday through Friday from 8 a.m. to 9 p.m. EST.

For dental benefit inquiries, please call:

• Now through December 31, 2025, call Healthplex at 1-866-795-6493 TTY 711 (Monday to Friday, 8:00 a.m. to 6:00 p.m. EST)
• Starting January 1, 2026, call DentaQuest at 1-844-231-8316 (Monday–Friday, 8:00 a.m.–6:00p.m. EST)

For hearing benefits, please call Hear USA at 1-800-442-8231, Monday through Friday, 8:00a.m. to 8:00 p.m. EST.

For TTY/TDD, call 711.

Within the first two weeks of enrollment, members will receive a Welcome Letter from HomeFirst, which provides contact information for their Care Management Team. Your Care Management Team is comprised of a Registered Nurse or Social Worker Care Manager, Care Coordinator, and a Registered Nurse or Social Work Assessor with expertise in caring for individuals with chronic medical needs.

Our Care Management Team will work cooperatively with your physician and other health care professionals to ensure you receive the services you need. An on-call nurse is available 24 hours a day, 7 days per week, to answer your questions.

Your Registered Nurse Assessor will complete an assessment at least twice a year and identify any changes or needs you may have.  Members may be assessed more frequently if there are requests for additional services, changes in personal care worker service hours, or after hospitalization.

Medicare or Medicaid Fee For Service will continue to cover your doctor, specialists, hospital care and drugs. Your Care Management Team will ensure you receive medical services by arranging and coordinating what you need, even if HomeFirst does not cover these services. If you need help accessing services, please contact Member Services from 8:30 a.m. to 5:00 p.m. at toll-free 877-771-1119.  For TTY/TDD, call 711.

To find providers in your area and update your address with HomeFirst, please call Member Services between 8:30 a.m. and 5:00 p.m. at toll-free 1-877-771-1119. For TTY, call 711. The change will become effective immediately. You can also find a list of our HomeFirst providers on our online directory at:  https://www.elderplan.org/member-benefits/homefirst-benefits/homefirst-provider-network/

To change your provider, simply inform HomeFirst of your intention to do so. Call Member Services from 8:30 a.m. to 5:00 p.m. at toll-free 1-877-771-1119. For TTY, call 711. The change will become effective immediately.

You may obtain a referral to a health care provider outside the network if HomeFirst does not have a provider with appropriate training or experience to meet your needs.

You can continue using the provider of your choice if you are receiving a covered service that is a Medicare benefit. HomeFirst recommends using a network provider so that you won’t have to change providers if your Medicare coverage limits are met. HomeFirst also has the ability to monitor the services of network providers and hold them accountable to our professional standards. HomeFirst is unable to monitor the services of providers that are not in the network.

If you plan to visit friends or family who live outside our service area, please inform your Care Management Team as soon as possible.  We will help you arrange for medically necessary care that you need while you are away.  You can contact Member Services toll-free at 1-877-771-1119, Monday through Friday, 8:30 am to 5:00 pm. For TTY, call 711. If you plan to leave the service area for more than 30 consecutive days, it will be challenging for HomeFirst to monitor your health needs effectively. When this happens, HomeFirst must initiate disenrollment.

If you have a problem with the care or treatment you receive from our staff or providers, call Member Services at 877-771-1119 or write to Member Services. You can also address your treatment by writing HomeFirst at the following address:

Elderplan, Inc.

55 Water Street, 46th Floor

New York, NY 10041

Attn: Appeals and Grievances Department

Plan “actions” that are subject to appeal can include:

• When HomeFirst denies or limits services requested by you or your provider.
• decides that a requested service is not a covered benefit.
• restricts, reduces, suspends or terminates services that we already authorized; or
• denies payment for services.

If we decide to deny, limit, or terminate the services you requested or decide not to pay for all or part of a covered service, we will send you a notice once we have made our decision. If we propose to restrict, reduce, suspend, or terminate an authorized service, we will send a letter at least 10 days before the intended change to the service.

If you disagree with an action that we have taken, you may appeal. When you file an appeal, it means that we must re-examine the reason for our action to determine if we were correct. You can file an appeal of an action with the plan orally or in writing. When the plan sends you a letter about an action it is taking (like denying or limiting services or not paying for services), you must file your appeal request within 60 calendar days of the date on our letter notifying you of the action. If we reduce, suspend, or stop the services you are getting now, you must file your appeal 10 days from the date of our letter notifying you of the decision or by the effective date of the decision if you want to keep your service the same until we make the decision on your appeal.

If you disagree with our decision on your appeal, you can ask for a Fair Hearing. You can also request a Fair Hearing if we have not made a decision on your appeal or if we have delayed the decision. You must first ask us for an appeal before requesting a Fair Hearing. You have 120 days from the date we issued the appeal decision to request a Fair Hearing.

If we reduced, suspended, or stopped services you are getting now, you must ask for a Fair Hearing 10 days from the date of our letter notifying you of the appeal decision or by the effective date of the decision, if you want to keep your service the same until the Fair Hearing decision is made.

Unless you request an expedited review, we will review your appeal of our action as a standard appeal and provide you with a written decision as promptly as your health condition allows, but no later than 30 days from the date we receive your appeal. An expedited review will be made within 72 hours of receipt of the appeal.(The review period can be increased up to 14 days if you request an extension or we need more information, and the delay is in your interest.) After receiving your appeal, we will send you the case file associated with your appeal. The case file includes medical records, documents, or any new or additional information considered, used or created in connection with the initial denial that will be used to make the appeal decision. If you would like to review the case file with us, you can call us to set up a date and time for you and/or your representative to review the case file. During our review, you will have a chance to present any supporting information. We will send you a notice about the decision we made about your appeal, including the date of our decision.

Please refer to your member handbook for additional details or call Member Services and ask to speak to your Care Manager, who will guide you through the process.

If you have a problem with the care or treatment you receive from our staff or providers, or you do not like the quality of care or services you receive from us, call Member Services at 877-771-1119. For TTY/TDD, call 711. You can also write to us with your complaint at:

Elderplan, Inc.

55 Water Street, 46th Floor

New York, NY 10041

Attn: Appeals and Grievances Department

Most problems can be solved right away. If it cannot be resolved right away, it will be reviewed by one or more qualified people, and we will let you know our decision within 45 days of when we have all of the information we need to answer your complaint, but you will hear from us in no more than 60 days from the day we get your complaint. If you disagree with a decision we made regarding your complaint, you or someone you trust can file a complaint appeal. Please refer to your member handbook or contact Member Services for more information.