MLTC Member Materials and Forms
Member Handbook Insert: Non-Emergency Transportation is Now Covered by Medicaid
Member Handbook InsertNew York Independent Assessor – Initial Assessment Process
Member Handbook Insert
MLTC Will Remove Service Limits for PT, OT, and ST
Dental Benefit Insert
Find an up-to-date list of in-network providers in your community. The search results are printable.
Forms and Personal Health Materials
CDPAS Recertification – Physician Order Form
MLTC members can have their home care service provided by a consumer directed personal care assistant through Consumer Directed Personal Assistance Services (CDPAS). The physician order form is required during the initial assessment and every six months during CDPAS recertification.
Download PDF: Form
Authorization for Release of Health Information Form (DOH 5032)
Health Information Exchange Fact Sheet and Form
Member Rights and Responsibilities Booklet
This booklet includes information on Member Rights, Patient Self-Determination Act, Making Decisions About Your Medical Care, Planning in Advance for Your Medical Treatment and Consumer Directed Personal Assistance Statement.
Joint Notice of Privacy Practices
See current and past issues of Member Newsletter for health tips and checklists, recipes, and more.