Medicaid Foster Care Drug Carve-out List

Effective July 1, 2021, the Foster Care Drug Carve-Out List will no longer apply and members will access the pharmacy benefit via the managed care plan, or Medicaid FFS, depending on enrollment status.

Medicaid-covered children/youth in the care of Voluntary Foster Care Agencies (VFCAs) or placed in foster homes certified by Local Departments of Social Services (LDSS) will be enrolled in Medicaid Managed Care Plans (MMCPs) on or after July 1, 2021, including in Mainstream MMCPs and HIV Special Needs Plans (HIV-SNP), unless they are otherwise excluded or exempt from mandatory Medicaid managed care. Effective July 1, 2021, VFCAs will no longer be payors for services provided to this population; providers will be reimbursed directly by Medicaid fee-for-service (FFS) or the children´s/youth´s MMCP.

For more information

New York State Medicaid Update - March 2021 Volume 37 - Number 3
New York State Medicaid Update - May 2021 Volume 37 - Number 6

29-I Health Facility (VFCA transition)
29-I Health Facility Billing FAQ – May 2021 (PDF)

FFS pharmacy coverage
Medicaid Pharmacy List of Reimbursable Drugs
NYS Medicaid Fee-for-Service Preferred Drug List

Medicaid Managed Care Pharmacy coverage
New York State Medicaid Managed Care (MMC) Pharmacy Benefit Information Center