Glossary
Primary care provider (PCP) , for the purposes of this directory, means the licensed physician or nurse practitioner who provides or coordinates all of the enrollee's health care needs and who works 16 hours or more per week at a particular site. PCP's generally practice in the following specialties: family and general practice, pediatrics, obstetrics and gynecology, and internal medicine. With the permission of the health plan, women may select an OB/GYN to serve as their PCP.
Medicaid Managed Care is a government program that pays for all medically necessary health care for many low-income children and some low-income adults, people with disabilities, and people with very high medical bills. Health services in Medicaid Managed Care are provided through a managed care organization.
Child Health Plus is the New York State health insurance program for children under 19 years of age that are not eligible for Medicaid and do not have private health insurance. Health services in Child Health Plus are provided through a managed care organization.
Managed care plans or health plans are organizations licensed by the state, which arrange primary care and other medically necessary services at a prepaid rate instead of billing for each individual service. Managed care plans use a network of providers to promote timely access to medical services. Each member receives a personal doctor or other primary care provider whose role is to increase the use of preventive and primary care services and thus reduce the unnecessary use of emergency rooms and possibly eliminate the need for hospitalization.
