HIV Special Needs Plans
HCAI has also participated in the development of HIV Special Needs Plans (HIV
SNPs) for populations needing more intensive services than those provided by
Medicaid managed care plans. Implementation of the HIV SNPs in New York City has
been a collaborative effort between the New York State Department of Health,
AIDS Institute; the New York City Department of Health and Mental and Mental
Hygiene, Division of Health Care Access and Improvement, and the New York City
Human Resources Administration. Currently there are three HIV SNPs enrolling
members.
Facts About HIV SNPs
In September 2010, The State Department of Health will begin to expand
mandatory managed are enrollment in NYC to Medicaid beneficiaries with HIV/AIDS.
Persons with HIV/AIDS who are currently exempt based upon their HIV infection
will no longer be considered exempt from mandatory enrollment in Medicaid
managed care. Consumers will have two to choices:
- • Enroll in an HIV Special Needs Plan or
- • Enroll in a Medicaid Managed Care Health Plan
HIV+ patients with Medicare, ADAP, or other exemptions or exclusions, or
private insurance will not be affected by this change.
Individuals interested in enrolling into an HIV SNP will be entitled to all
the benefits available from a Medicaid Managed Care Health Plan along with
additional services such as:
- • HIV SNP Case Management Services
- • Treatment Adherence Services
- • HIV Prevention and Risk-Reduction Education
Certain services such as prescription/non-prescription drugs, and certain
other services will remain on a fee-for-service basis. If a consumer enrolls in
an HIV SNP, s/he will use his/her Medicaid benefits card to access these
services.
If a consumer enrolls in a mainstream health plan and wants to enroll in an
HIV/SNP, s/he must disenroll from the mainstream health plan and complete a new
enrollment form for the HIV/SNP.
Non-infected children of SNP enrollees under the age of 19 can join the SNP
too.
Persons with HIV can enroll in an HIV/SNP regardless of current family member
enrollment into a Medicaid managed care health plan - this is an exception to
the "same family rule."
If a consumer is currently seeing a provider and wants to continue to see
that provider, the health plan should assist him/her in making sure that the
provider also participates in the HIV SNP provider network or s/he can call New
York Medicaid CHOICE at 1-800-505-5678. Before making the final choice, the
consumer should call the provider to make sure that the doctor is taking new
patients.
If the consumer is ready to enroll or needs more time to decide which option
s/he wishes to consider, the Marketing Representative is responsible for giving
him/her a business card which should have his name, the name of the health plan
and a telephone contact number.
If the consumer has a newborn after she enrolls in an HIV/SNP or a Medicaid
managed care plan, the baby will be automatically enrolled in the same health
plan as the mother.
Related Information
