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Office of Mental Health

Medicaid Managed Care Complaints Overview

There may be times when a Medicaid Managed Care enrollee or a provider is not satisfied with the care or services that a Medicaid Managed Care plan is providing to the enrollee. In those situations, enrollees and providers may file a formal complaint with the plan, the State, or both.

  • Filing a complaint with the Medicaid Managed Care plan. A provider, enrollee, or an enrollee’s authorized representative can file a complaint with the plan. The Medicaid Managed Care plan will review the complaint and notify the person who made the complaint about the decision that is made. If the person who made the complaint disagrees with the plan’s decision, that person can file a “complaint appeal” with the Medicaid Managed Care plan.
  • Filing a Complaint with New York State. A provider, enrollee, or an enrollee’s authorized representative can file a complaint with the State at any time. A complaint does not have to be filed with the plan before it can be filed with the State. Depending on the type of Medicaid Managed Care plan and the kind of complaint, there are different agencies that can help. Please see chart below for further information.
NYS Medicaid Managed Care Enrollee and Provider Contacts for Questions/Complaints
Type of Question/ Complaint How to file/ Get more information
  • Denied referrals
  • Concerns about the delivery of care
  • Termination issues
  • Access and availability
  • Difficulty getting appointments, health care or type of doctor needed
  • Billing concerns or plan's refusal to pay for a covered service
  • Dissatisfaction with quality of care
NYS Department of Health
Bureau of Consumer Services Complaint Unit
One Commerce Plaza, Room 1609
Albany, NY 12210
Phone: 1-800-206-8125
Email: Managed Care Complaints
Information About Complaints and Appeals
  • Late payments by a plan
  • Prompt payment law
NYS Department of Financial Services
One Commerce Plaza
Albany, NY 12257
Department of Financial Services Website
  • Consumer health-related complaints
  • Consumer health care rights
  • Fraudulent, misleading or deceptive practices
NYS Office of the Attorney General - Health Care Bureau
The Capitol
Albany, NY 12224-0341
Phone: 1-800-428-9071
Attorney General's Office Health Care Bureau Website
  • Eligibility questions
  • Enrollment issues
New York Medicaid Choice
Phone: 1-844-HARP-999 (1-844-427-7999)
Local Department of Social Service (Medicaid Office)
List of Local Departments of Social Services (Medicaid Offices)
  • Questions or complaints related to Mental Health programs or services
NYS Office of Mental Health
Phone: 1-800-597-8481
E-mail: For questions or comments related to behavioral health managed care:
OMH Managed Care
NYS OMH Managed Care Website
  • Questions or complaints related to Substance Use Disorder programs or services
NYS Office of Alcoholism and Substance Abuse Services
Phone: 518-473-3460
E-mail: PICM
NYS OASAS Managed Care Website

Please contact OMH Managed Care with any questions, comments, or problems you may be experiencing with this site. If you would like to file a complaint about behavioral health managed care, please visit the Information on Filing a Complaint page. Providers, if you have any questions about the managed care implementation, please complete and send a question form.