Member Materials and Forms
On this page, you can find important documents related to your Senior Whole Health of New York health plan. Click the links below to download each document.
2026 Handbooks and Inserts
Effective 4/1/26: Interoperability Service Authorization Timeframe Change
2025 Handbooks and Inserts
2025 MLTC Member Handbook- English
2025 MLTC Member Handbook- Bengali
2025 MLTC Member Handbook- Chinese
2025 MLTC Member Handbook- Haitian Creole
2025 MLTC Member Handbook- Korean
2025 MLTC Member Handbook- Russian
Effective 9/1/25; Minimum Needs Requirements
Effective 3/4/25: Electronic Noticing
Effective 1/1/25: Social Care Network Insert
Effective 1/1/25: Social Care Network
2024 Handbooks and Inserts
MAP Non-emergency Medical Transportation 30 Day Member Insert
MAP Dental Services
MLTC Non-emergency Medical Transportation 30 Day Member Insert
Dental Services
2022 Handbooks and Inserts
Senior Whole Health of New York Member Handbook
Effective May 16, 2022 - Change in Initial Assessment Process for New York Independent Assessor
General Information
Notice of Privacy Practices
Disenrollment Rights
Dental Services Providers
Member Forms
Appointment of Representative Form
Health Care Proxy
Medicare Member Education
2024 Guide to Getting Quality Health Care
2025 Guide to Getting Quality Health Care
This report shows how prior authorization requests are handled, such as how many were approved or denied and how quickly decisions were made. To find out if a specific service needs prior authorization, members and providers should check the plan’s Prior Authorization Guide or use the Prior Authorization Lookup Tool.
Prior Authorization Guide
Prior Authorization Lookup Tool
Senior Whole Health of New York Medicaid Prior Authorization Annual Report 2025
NY SWH Medicaid MLTSS Prior Authorization Report 2025
| Prior Authorization Statistics |
Molina Healthcare Inc
Percentage
|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. |
87% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. |
13% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. |
16% |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
0% |
| The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
35% |
| The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
NA |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
87% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
13% |
|
Timing |
| Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
3 |
| Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
1 |
| Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
79 |
| Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
43 |
SWHNY FIDE Medicaid Prior Authorization Report 2025
| Prior Authorization Statistics |
Molina Healthcare Inc
Percentage
|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. |
100% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. |
0% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. |
NA |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
NA |
| The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
NA |
| The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
NA |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
NA |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
NA |
|
Timing |
| Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
5 |
| Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
3 |
| Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
NA |
| Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
NA |
| |
Senior Whole Health of New York Medicare Prior Authorization Annual Report 2025
H5992 Prior Authorization Report 2025
| Prior Authorization Statistics |
Molina Healthcare Inc
Percentage
|
| The percentage of STANDARD prior authorization requests that were approved, aggregated for all items and services. |
92% |
| The percentage of STANDARD prior authorization requests that were denied, aggregated for all items and services. |
8% |
| The percentage of STANDARD prior authorization requests that were approved after an appeal, aggregated for all items and services. |
30% |
| The percentage of EXPEDITED prior authorization requests that were approved after an appeal, aggregated for all items and services. |
100% |
| The percentage of STANDARD prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
38% |
| The percentage of EXPEDITED prior authorization requests for which the review timeframe was extended, and the request was approved, aggregated for all items and services. |
0% |
| The percentage of EXPEDITED prior authorization requests that were approved, aggregated for all items and services. |
88% |
| The percentage of EXPEDITED prior authorization requests that were denied, aggregated for all items and services. |
12% |
|
Timing |
| Average time that elapsed between the submission of a request and a determination by the payor, plan or issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
2 |
| Median time that elapsed between the submission of a request and a determination by the payor, plan, issuer, for STANDARD prior authorizations, aggregated for all items and services. (Measured in days) |
1 |
| Average time that elapsed between the submission of a request and a decision by the payor, plan or issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
18 |
| Median time that elapsed between the submission of a request and a decision by the payor, plan, issuer, for EXPEDITED prior authorizations, aggregated for all items and services. (Measured in hours) |
17 |
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