Essential Plan 200-250 Coverage to End July 1, 2026
How You Can Prepare and Support Your Patients
The New York State Essential Plan coverage for individuals with incomes between 200% and 250% of the Federal Poverty Level will end effective July 1, 2026.
Explore helpful Healthfirst plan resources for 2026
Healthfirst offers health plans for all New Yorkers
Updated Healthfirst at a Glance guides offer an overview of Healthfirst's plan offerings for 2026.
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What's New
View allRequesting Copies of Provider 1099s and B Notice Inquiries
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View postPhysical Therapy Authorization and Approval Guidance Effective January 31, 2026
A provider questionnaire will now accompany initial prior authorization requests for Adult Physical Therapy across all Healthfirst plans to support efficient reviews and appropriate care decisions.
View postIntroducing Claim Pattern Review Program from Cotiviti
Effective August 1, 2026, Healthfirst will implement Cotiviti’s Claim Pattern Review Program to conduct ongoing reviews of specific professional claims.
View postPrior Authorization Required for Select Codes Starting April 1, 2026
Effective April 1, 2026, Healthfirst will require prior authorization requirements for several CPT codes currently managed by Evicore.
View postPrior Authorization Required for Select Codes Starting June 1, 2026
Codes newly released by the Centers for Medicare and Medicaid Services (CMS) on April 1, 2026, will include prior authorization requirements starting June 1, 2026.
View postPrior Authorization Required for Select Codes Starting July 1, 2026
Effective July 1, 2026, Healthfirst will require prior authorization requirements for several CPT codes.
View postAvaility Essentials is Healthfirst's New Provider Portal
Providers can access all Healthfirst tools through Availity Essentials, our new secure provider portal platform.
View postIntegra Partners to Manage Durable Medical Equipment, Prosthetics, Orthotics, and Supplies Prior Authorization Requests
Effective June 1, 2026, Integra Partners will manage prior authorization (Utilization Management) for all Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) on behalf of Healthfirst for all plans.
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