Disenrollment Rights

Senior Whole Health of New York will not pursue disenrollment based on a member's health status, and need for or cost of covered services.

You Can Choose to Disenroll

You may leave the Senior Whole Health of New York Medicaid Advantage Plus Plan at any time, for any reason.

To request disenrollment, call or write to Senior Whole Health of New York. It could take up to six weeks to process, depending on when your request is received. Disenrollment from a plan is effective the last day of a month. Enrollment in a new plan is effective the first day of a month. You may disenroll to regular Medicaid or join another health plan as long as you qualify.

The Senior Whole health of New York member services team is available to help you with any questions or even to help you leave our plan. We can be reached at 1-877-353-0185, TTY/TDD: 711, 7 days a week 8 a.m. - 8 p.m.

You Will Have to Leave Senior Whole Health of New York Medicaid Advantage Plus Plan if you:

  • Are no longer in Senior Whole Health of New York for your Medicare coverage;
  • Permanently move out of the Senior Whole Health of New York service area;
  • Are out of the plan's service area for more than 90 consecutive days;
  • Become a resident of an alcohol or substance abuse services program;
  • Receive services from the Offices for People with Developmental Disabilities (OPWDD);
  • Join a Long-Term Home Health Care program or a Home and Community Based Services Waiver program;
  • Become incarcerated;
  • Need nursing home care, but are not eligible for institutional Medicaid;
  • No longer require long term care services; Senior Whole Health of New York NHC must disenroll you from our plan if you no longer require community-based long term care services.

We Can Ask You to Leave the Plan

We will ask that you leave Senior Whole Health of New York if:

  • You, your family member, or your caregiver behave in a way that prevents the plan from providing the care you need;
  • You provide false information or behave in a deceptive or fraudulent way;
  • You fail to complete and submit any consent form or other document that is needed to obtain services for you.
You may be disenrolled if:

  • You or others in your home knowingly exhibit abusive, disruptive or uncooperative behavior to such a degree as to jeopardize the provision of care;
  • You knowingly provide false information or engage in fraudulent conduct;
  • You knowingly fail to complete and submit requested documentation.
Senior Whole Health of New York will work with you to attempt to resolve these issues. If the issues are not resolved, then Senior Whole Health of New York will notify HRA of request for disenrollment. HRA must agree with any involuntary disenrollment, and will send written notification of such to you. Senior Whole Health of New York will continue to provide or arrange for the provision of the covered services to you until the effective date of your disenrollment. Program personnel will assist you with arrangements for future services from another provider. The time frame for the effectiveness involuntary disenrollment is the same as for voluntary disenrollment.

Re-Enrollment Provisions

If you voluntarily disenroll, you will be allowed to re-enroll in the program if you meet our eligibility criteria for enrollment. If you are involuntarily disenrolled, Senior Whole Health of New York may not accept your request for enrollment.

Last Updated 10/11/2019