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Provider Alerts - Claims & Billing - Policy, Billing, or Coverage Update - 2026
CMS Cell and Gene Therapy (CGT) Access Model for Casgevy™ (exagamglogene autotemcel) and Lyfgenia® (lovotibeglogene)

Medicaid Practitioner Administered Drugs Update

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Healthfirst Plans
Medicaid
  
Compliance, Regulatory & Policies - Policy, Billing, or Coverage Update - 2026
Reimbursement Policy: PO-RE-157 ESRD Oral-Only Renal Dialysis Services – Drugs & Biologicals

Effective January 1, 2025, in accordance with CMS updates to the ESRD Prospective Payment System (PPS), oral-only renal dialysis service drugs and biologicals, specifically phosphate binders, will be incorporated into the ESRD PPS bundled payment model.

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Reimbursement Policy
  
Plans & Benefits - Practice Guidelines and Tips - 2026
2026 Healthfirst Plans at a Glance

Healthfirst has health plans made for New Yorkers.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst Member ID Cards

View Healthfirst Member ID Cards at a glance.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - 65 Plus Plan (HMO)

A Medicare Advantage plan with hospital, medical, and prescription drug coverage all in one plan

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - The Essential Plan

Federally subsidized plans for individuals who are ineligible for Medicaid due to income or immigration status.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - CompleteCare (HMO D-SNP)

A Medicaid Advantage Plus plan that combines Medicare and Medicaid benefits with long-term care services.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Connection Plan (HMO D-SNP)

For those who are dual-eligible for both Medicare and cost-sharing assistance from Medicaid.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Increased Benefits Plan (HMO)

A Medicare Advantage plan for eligible Medicare beneficiaries who qualify for Extra Help, also known as Low-Income Subsidy (LIS), which helps people with Medicare pay lower prescription drug costs.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Leaf and Leaf Premier

Our Leaf and Leaf Premier plans offer two levels of coverage for individuals and families. They are Qualified Health Plans certified by the NYSOH marketplace.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Life Improvement Plan (HMO D-SNP)

A Medicare Advantage special needs plan for individuals who are eligible for Medicare and Medicaid. Most Life Improvement Plan members have fee-for-service (FFS) Medicaid benefits administered by the New York State Department of Health.

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Healthfirst Plans
  
Plans & Benefits - Practice Guidelines and Tips - 2026
Healthfirst at a Glance - Signature (HMO)

A Medicare Advantage plan for those looking for hospital, medical, and prescription drug coverage all in one plan with a flexible benefit card to help pay for member cost shares.

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Healthfirst Plans
  
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