Complaints, Service Requests, and Appeals (HomeFirst)

Not sure? Call Member Services at 1-877-771-1119 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m. After hours, call the same number to reach an on-call nurse.

Prescription drugs: HomeFirst does not cover prescription drugs. Most drugs are covered by regular Medicaid, or by Medicare Part D if you have Medicare. Drug exceptions are not part of HomeFirst.

You or your provider can call Member Services at 1-877-771-1119 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m. Or send your request in writing to:

HomeFirst
Attn: Coordinated Care
55 Water Street, 46th Floor
New York, NY 10041

All covered services, except emergency services, need approval before you get them (prior authorization). Asking for more of a service you already get is called concurrent review.

You or your doctor can ask for a fast review if waiting could seriously harm your health. If we need more information, we can take up to 14 more calendar days. We will tell you in writing why.

If you do not agree that we should take more time, you can make a complaint with us. You can also complain to the New York State Department of Health at 1-866-712-7197.

We will tell you and your provider by phone and in writing if we approve or deny your request, and why. If we plan to reduce, suspend, or stop a service, we will usually send the letter at least 10 calendar days before the change.

• Deadline: Ask within 60 days of the date on our letter about the action.
• How: Call or write to us.
• Keep your services during your appeal: If we are reducing, suspending, or stopping a service you already get, ask for your appeal within 10 days of the date on the notice, or by the date the change would start, whichever is later.
• How long it takes: Standard appeal, within 30 days. Fast appeal, within 72 hours. We will always use a fast review if the appeal is about more of a service you already get. We can take up to 14 more days if you ask or if we need more information and the delay helps you.

We will send you a letter saying we got your appeal, with a copy of your case file. Clinical staff who were not part of the first decision will review it. If you keep getting services during your appeal and we do not decide in your favor, you may have to pay for those services.

State Fair Hearing

If we do not decide your appeal fully in your favor, you can ask New York State for a Fair Hearing. Ask within 120 calendar days of the date on our final appeal decision letter. To keep your services while you wait, ask within 10 days of the date we sent our appeal decision, or by the date the change would start, whichever is later.

• Online: otda.ny.gov/hearings/request (opens a non-Elderplan website)
• Phone: Standard Fair Hearing line 1-800-342-3334. Emergency Fair Hearing line 1-800-205-0110. TTY: call 711 and ask the operator to call 1-877-502-6155.
• Fax: 518-473-6735
• Mail: NYS Office of Temporary and Disability Assistance, Office of Administrative Hearings, Managed Care Hearing Unit, P.O. Box 22023, Albany, New York 12201-2023
• In person: New York City: 14 Boerum Place, 1st Floor, Brooklyn, New York 11201. Albany: 40 North Pearl Street, 15th Floor, Albany, New York 12243. [The 2026 Plus Long-Term Care EOC lists 5 Beaver Street, New York, for New York City. Confirm the current address.]

External Appeal

If we deny your appeal because we decide the service is not medically necessary, or is experimental or investigational, you can ask New York State for an External Appeal. It is free. File the form with the New York State Department of Financial Services within 4 months from the date we denied your appeal.

• Call 1-800-400-8882
• Go to dfs.ny.gov (opens a non-Elderplan website)
• Write to New York State Department of Financial Services, One State Street, New York, NY 10004-1511, or Consumer Assistance Unit, One Commerce Plaza, Albany, NY 12257
• Call HomeFirst at 1-877-771-1119 (TTY 711) for help

An External Appeal is decided within 30 days. A fast External Appeal is decided in 72 hours or less. You can ask for both a Fair Hearing and an External Appeal. If you do, the Fair Hearing decision is the one that counts.

A complaint is when you tell us you are unhappy with the care or treatment you got from our staff or providers. For example, someone was rude to you, did not show up, or you do not like the quality of your care.

Call Member Services at 1-877-771-1119 (TTY 711), or write to:

HomeFirst

Attn: Appeals and Grievances

55 Water Street, 46th Floor

New York, NY 10041

Give us your name, address, phone number, and details about the problem. We will send a letter saying we got your complaint.

Complaint appeal

If you do not agree with our complaint decision, you can ask for a second review. Call or write to us within 60 work days of getting our decision.

• Standard complaint appeal: we decide within 30 work days after we get the information we need.
• Fast complaint appeal (if a delay would put your health at more risk): we decide within 2 work days after we get the information we need.

• Member Services: 1-877-771-1119 (TTY 711), Monday through Friday, 8:30 a.m. to 5 p.m. After hours, call the same number to reach an on-call nurse.
• Independent Consumer Advocacy Network (ICAN): Free, independent help with your coverage, complaints, and appeals. Call 1-844-614-8800 (TTY Relay 711). Website: icannys.org (opens a non-Elderplan website). Email: ican@cssny.org.
• New York State Department of Health: If you cannot fix a problem with us, you can complain at any time. Call 1-866-712-7197, or write to NYS Department of Health, Bureau of Managed Long-term Care, Suite 1620, One Commerce Plaza, 99 Washington Avenue, Albany, NY 12210.
• Someone to act for you: You can choose a family member, friend, or provider to act for you. Call Member Services or your Care Management Team for the form.

2026 HomeFirst Member Handbook: “Service Authorizations, Actions and Action Appeals” and “Complaints and Complaint Appeals”

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