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  • Medicaid Claim Coverage Rules

  • Affinity Health Plan follows Medicaid guidelines for our Medicaid and HARP members, as set by the New York State Department of Health (DOH). Those guidelines include rules on what is covered as well as rules on what is medically necessary. The DOH updates Medicaid covered services on a periodic basis. For example, viscosupplementation of the knee for osteoarthritis has been eliminated, so Affinity will not cover this procedure or the drugs used for Medicaid and HARP members.

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    Affinity Health Plan will not pay claims for services/treatments that Medicaid does not cover.