New York Medicaid Specialist Referral Rules: What Has Changed
New York Medicaid Specialist Referral Rules: What Has Changed
Starting January 01, 2026, UnitedHealthcare Community Plan of New York no longer requires referrals for one follow-up visit with certain specialists when the visit takes place within 7 days of a member’s discharge from the hospital or emergency room.
This change applies to these specialist categories:
- Allergy and immunology
- Dermatology
- Endocrinology
- Gastroenterology
- General surgery
- Neurological surgery
- Orthopedic surgery
- Otolaryngology
- Physical medicine and rehabilitation/physiatry
- Plastic surgery
- Podiatry
- Pulmonary medicine
- Sports medicine
- Urology
- Vascular surgery
The referral waiver applies only to the first follow-up visit after discharge. If the member needs more visits after that, the specialist must get a referral from the member’s primary care provider (PCP) to continue care.
If a member is not connected with a PCP or does not know who their PCP is, UnitedHealthcare asks the member to call Member Services using the phone number listed on the back of their ID card.
Providers who need help can also use the chat feature in the UnitedHealthcare Provider Portal, which is available 24/7.
