Medicaid and Medicaid HARP

The following updates have been made to your CDPHP Medicaid plan:

School-Based Health Center Services

Starting April 1, 2025, Capital District Physicians’ Health Plan, Inc. (CDPHP^®) will cover services from School-Based Health Centers (SBHC).

What are SBHC services?

A SBHC is located in a school and is available to the students enrolled in that school. SBHCs offer a variety of primary medical, social, mental health, and health education services including, but not limited to:

• Health check-ups and well-child visits,

• Diagnosis and treatment of injuries and sickness,

• Diagnosis and ongoing care of chronic health problems,

• Family planning and reproductive health services,

• Dental services such as oral exams and fluoride treatments, and

• Some SBHCs have dental clinics which also offer cleanings, fillings, and other preventive and restorative services.

To learn more about these services, please call Member Services at 1-800-388-2994. TDD/TTY: 711.

Doula Services

Starting April 1, 2025, Capital District Physicians’ Health Plan, Inc. (CDPHP®) will cover doula services during pregnancy and up to 12 months after the end of pregnancy, no matter how the pregnancy ends. Currently, members can access doula services by using their Medicaid card. Beginning April 1, 2025, you can use your CDPHP plan card to receive doula services.

What is a Doula?

Doulas provide physical, emotional, educational, and non-medical support for pregnant and postpartum persons before, during, and after childbirth or end of pregnancy.

What Doula Services are Available?

Doula services can include up to eight (8) visits with a doula during and after pregnancy and continuous support while in labor and during childbirth. If you become pregnant within the 12 months following a prior pregnancy, your eligibility for doula services will start over with the new pregnancy. Any unused doula services from the prior pregnancy will not carry over.

Doula services may include:

• The development of a birth plan;

• Ongoing support throughout the pregnancy;

• Continuous support during labor and childbirth;

• Education and information on pregnancy, childbirth, and early parenting;

• Assisting with communication between you and your medical providers; and

• Connecting you to community-based childbirth and parenting resources.

Eligibility

If you are pregnant or have been pregnant within the last 12 months, you are eligible for doula services. You are eligible for these services with each pregnancy.

If you started to receive doula services with a Medicaid-enrolled doula(s) before April 1, 2025, your doula services will continue to be covered until 12 months after the end of your pregnancy. If you start to receive doula services on or after April 1, 2025, your doula needs to participate with CDPHP.

To learn more about these services, call Member Services at 1-800-388-2994. TDD/TTY: 711.

Social Care Network Benefit

Starting January 1, 2025, you can connect to organizations in your community that provide services to help with housing, food, transportation, and care management at no cost to you, through a regional Social Care Network (SCN).

• Through this SCN, all Medicaid members can meet with a Social Care Navigator who can check your eligibility for services that can help with your health and well-being. They will ask you questions to see where you might need some extra support.

• If you or your child qualifies for services, the Social Care Navigator can work with you to get the support you need. You may qualify for more than one service, depending on your situation. These services include:

  • Housing and utilities support:

    • Installing home modifications like ramps, handrails, grab bars to make your home accessible and safe.

    • Repairing and fixing water leaks to prevent mold from growing in your home.

    • Sealing holes and cracks to prevent pests from entering your home.

    • Providing an air conditioner, heater, humidifier, or dehumidifier to help improve ventilation in your home.

    • Helping you find and apply for safe and stable housing in the community.

  • Nutrition support:

    • Getting help from a nutrition expert who will give you guidance and support in choosing healthy foods to meet your health needs and goals.

    • Getting prepared meals, fresh produce, or grocery items delivered to your home for up to six (6) months. These food items will be tailored to your specific health needs.

    • Providing cooking supplies like pots, pans, microwave, refrigerator, and utensils to prepare meals.

  • Transportation services:

    • Helping you with access to public or private transportation to places approved by the SCN such as: going to a job interview, parenting classes, housing court to prevent eviction, local farmers’ markets, and city or state department offices to obtain important documents.

  • Care management services:

    • Getting help with finding a job or job training program, applying for public benefits, managing your finances, and more.

    • Getting connected to services like childcare, counseling, crisis intervention, health homes program, and more.

If you are interested, please call member services at 1-800-388-2994 (TDD/TTY: 711) and we will connect you to a SCN in your area. The Social Care Navigator will verify your eligibility, tell you more about these services, and help you get connected to them.

Home-Delivered Medically Tailored Meals Program

Effective January 1, 2025, Capital District Physicians' Health Plan, Inc. (CDPHP^®) will no longer cover the Home-Delivered Medically Tailored Meals program.

CDPHP wants to ensure our members remain happy, healthy, safe, and secure. If you have been receiving home-delivered meals through the program, your CDPHP care manager should have already notified you about the change, along with other options available to you.

If you have questions, please call Member Services at 1-800-388-2994 (TDD/TTY: 711).