What's in your 2027 MAP (Medicaid Advantage Plus) member handbook

In short: if you are in a Medicaid Advantage Plus (MAP) plan, the 2027 model member handbook from the New York State Department of Health is the plain-language guide to how your plan should work. Keep it with your Medicare Evidence of Coverage. Use it to see how to ask for a service, file a complaint or appeal, leave the plan, or get notices by email or text instead of only by mail. Your own plan inserts its phone numbers and hours; this page explains the shared rules.

Last checked October 15, 2026, against the Department of Health 2027 MAP Model Member Handbook linked from the MLTC page. This is not a government site, and it is not your plan's personal handbook.

What this handbook is (and is not)

MAP is the Medicaid long-term-care half that sits with a matching Medicare Dual Special Needs Plan (D-SNP) from the same company. Our D-SNP vs MAP guide explains the pairing. The model handbook says it covers the extra Medicaid benefits in MAP—home care, personal care, adult day health care, and other community-based long-term services—and how to request a service, file a complaint, or disenroll. Medicare hospital, doctor, and drug rules live in the plan's Medicare Evidence of Coverage. You need both documents.

Enrollment in MAP is voluntary. To join, the model handbook says you generally must be 18 or older, live in the plan's service area, have Medicaid and Medicare Parts A and B, enroll in that company's D-SNP, and need community-based long-term services and supports for more than 120 days while meeting the state's Minimum Needs rules (help with more than two activities of daily living, or supervision with more than one ADL if you have a Dementia or Alzheimer's diagnosis). The New York Independent Assessor Program (NYIAP) does the first assessment.

How to request a service

Asking the plan to approve a treatment or service is a service authorization request (also called a coverage decision). The model handbook says you or your provider can call Member Services or write to the plan. Member Services is listed as available 24 hours a day, seven days a week, at the number in your handbook and on your ID card.

• Prior authorization: some services need approval before you get them. Your handbook lists which ones.
• Concurrent review: ask for more of a service you already get.
• Standard timing: for a prior authorization, the plan generally answers within three workdays of having all the information it needs, and no later than seven calendar days after it gets your request. For a concurrent review, one workday after it has what it needs, and no later than seven calendar days.
• Fast track: if waiting could seriously harm your health, ask for a fast decision. The handbook says the plan answers within one workday of having the information, and no later than 72 hours after the request. Your provider can trigger a fast review automatically.
• Extra time: the plan can take up to 14 more calendar days if you ask for more time or if missing records would help your case. It must tell you in writing why.

If the plan cuts, pauses, or stops a service you already have, it must usually tell you at least 10 days before the change. You may be able to keep the service while you appeal; see below and our MAP and D-SNP denial appeal steps.

Your Care Manager (usually a nurse or social worker) helps build your Person Centered Service Plan and arrange services. For Consumer Directed Personal Assistance (CDPAS), the statewide fiscal intermediary is Public Partnerships Ltd. (PPL): Support Center 1-833-247-5346 or TTY 1-833-204-9042 (pplfirst.com/cdpap), as stated in the model handbook.

Complaints and appeals (the short version)

The handbook separates complaints (problems with care, staff, or quality) from appeals (you disagree with a coverage or payment decision). Call or write Member Services. For MAP, most Medicare and Medicaid benefits use one integrated appeal process.

• Level 1 appeal: file with the plan, generally within 60 days of the Integrated Coverage Determination Notice.
• Aid continuing: if services are being reduced, suspended, or stopped, ask for a Level 1 appeal within 10 days of being told, or by the date the change is scheduled, whichever is later, if you want services to continue during the appeal.
• Fast appeal / fast complaint: ask when delay could harm your health; fast complaints about timing get an answer within 24 hours per the model handbook.
• After a Level 1 denial: Medicare-covered items often go automatically to an independent reviewer. For many Medicaid-only services (such as home care hours), you can request a State Fair Hearing. You may also have a New York External Appeal for some medical-necessity denials. Details and deadlines are on our appeals guide.

At any time you can complain to the New York State Department of Health about review timing at 1-866-712-7197. Free help with coverage, complaints, and appeals: ICAN at 1-844-614-8800 (TTY Relay 711), icannys.org.

Leaving your MAP plan

You can ask to leave at any time for any reason (voluntary disenrollment). Call Member Services. The model handbook says processing can take up to six weeks. If you still need community-based long-term services, you must join another MLTC plan or a Home and Community Based waiver program to keep that kind of care. New York Medicaid Choice's long-term care line is 1-888-401-6582 (TTY 1-888-329-1541).

The plan may start an involuntary disenrollment only for listed reasons—for example, you leave the aligned Medicare plan, lose Medicaid, move out of the service area for more than 30 consecutive days, no longer meet Minimum Needs at reassessment, stop receiving a qualifying CBLTSS service (Social Adult Day Care alone does not count), join certain residential waiver programs, or refuse a required reassessment. High use of services or a change in your health is not a reason to remove you. The plan must get approval through New York Medicaid Choice (or another state-designated entity) before involuntary disenrollment.

Open Enrollment tip: switching to a different Medicare Advantage or drug plan can take you out of the aligned D-SNP and trigger MAP disenrollment under MLTC Policy 26.01. Read our Open Enrollment checklist for people with Medicare and Medicaid before you change anything.

Electronic notices

The model handbook says your plan (and its vendors) can send notices about service authorizations, plan appeals, complaints, and complaint appeals electronically instead of only by phone or mail. The same option can cover the member handbook, provider directory, and some benefit-change notices. You must ask for electronic delivery and tell the plan how you want mail-type notices and phone-type notices delivered (for example email, text, web portal, or fax—your handbook lists what that plan offers). The plan then confirms your choice by mail.

Who to call

• Your MAP Member Services — number on your plan ID card and in your handbook (24/7 per the model).
• ICAN (free ombudsman): 1-844-614-8800 (TTY Relay 711).
• HIICAP (free Medicare counseling): 1-800-701-0501.
• New York Medicaid Choice (MAP / MLTC / PACE enrollment): 1-888-401-6582.
• NYS DOH (complaint about appeal timing): 1-866-712-7197.

Want help with this? Get free one-on-one guidance.

If you want someone to walk through your MAP handbook, a denial, or whether staying in MAP fits for 2027, our short plan-help tool ends with an optional request for free one-on-one guidance. Nothing is enrolled without your say-so. HIICAP and ICAN remain free, separate choices.