Referrals and preapprovals in NY

For some Medicaid services, you’ll need a referral from your primary care provider (PCP) before getting care.

When to get a referral in New York


You’ll need to get a referral from your PCP before:


 Meeting with a specialist.


 Going to a hospital for nonemergency care.


 Getting certain medicines, tests, and services.


Self-referral services


For most services, you'll go to your PCP or another provider in our plan. But there are some services we'll pay for, even if you get them from a provider who's not in our plan. These are called self-referral services.


You don’t need a referral from your PCP for:


 Emergency care


 Urgent care


 Women’s healthcare services


 Maternal depression screening


 Family planning services


 Behavioral health services (mental health and substance use)


 Dental care from a LIBERTY Dental plan dentist (select plans)


 Vision care from a plan provider (select plans)


 HIV and STI screenings


 Smoking cessation services

You may need preapproval for a service


A preapproval is when your doctor asks us to approve a service before you receive it. Your PCP will work with us to get the preapprovals you need.


Your PCP will need to send in a preapproval for:


 Some ambulatory surgery


 Certain chemotherapy not covered by NYRx




 Durable medical equipment


 Growth hormone evaluation


 Digital hearing aids


 Home care


 Hyperbaric oxygen therapy


 Inpatient services




 Non-emergent fixed wing transportation


 Obstetrical services (except family planning services)


 Prosthetics and orthotics


 Some physician-administered drugs not covered by NYRx


 Transplant evaluation

Have questions?


Check your member handbook or live chat with a representative through the online portal or the Sydney Health app.