Your Rights If You Leave HomeFirst

Annual Notice of Disenrollment Rights

Being in HomeFirst is your choice. You can leave.

But if you still need long-term care services at home, you must be in a managed long-term care plan to get them. So if you leave HomeFirst and still need care at home, you must pick another plan through New York Medicaid Choice. You can also go back to regular Medicaid, but then you will not get long-term care services at home.

When can you leave?

• In your first 90 days: You can leave and join another plan for any reason.
• After your first 90 days, you need to stay for 9 more months unless you have a good reason. New York State calls this “good cause.”

Some good reasons include:

• You move out of our service area.
• You, HomeFirst, and your county Department of Social Services or the New York State Department of Health all agree that leaving is best for you.
• Your home care provider does not work with our plan.
• We have not provided the services required under our contract with the State.

One exception: If you qualify, you can move to a different kind of long-term care plan at any time, with no good cause needed. Those plans are:

• MAP (Medicaid Advantage Plus) — a plan that combines Medicare and Medicaid
• PACE (Program of All-Inclusive Care for the Elderly)

How to leave

Call New York Medicaid Choice at 1-800-505-5678. Their counselors are free and can help you change plans.

If you feel you no longer need long-term care services at all, call Member Services or your Care Management Team. Your Care Manager will send you a letter confirming your request. We will also forward your request to your local Department of Social Services or New York Medicaid Choice for processing.

When we may have to ask you to leave

There are a few reasons we may need to end your membership. One example is if you no longer live in our service area. The full list and how the process works are in your Member Handbook.

When does leaving take effect?

Your local Department of Social Services or New York Medicaid Choice decides your last day, based on when they process your request.

What we must do until your last day

Until your last day, HomeFirst will continue to cover all of your benefits. That does not change while your request is being processed.

After your last day, we will make the referrals you need for services we no longer cover, so your care does not stop.