HIV Special Needs Plans (HIV SNPS)

Medicaid Health Plan Choices for People Living with HIV/AIDS

If you are living with HIV/AIDS and you get Medicaid, you can choose from several Special Needs Plans (SNP - sounds like "snip").

A SNP is a health plan that covers all the same services covered by other Medicaid health plans, PLUS special services for people living with HIV/AIDS. If you live in Metropolitan New York, there are several SNPs for you to choose from.

When you join a SNP, you will get:

  • An HIV Specialist primary care provider
  • HIV Care Coordination services
  • Information about HIV medications and side-effects
  • Treatment adherence services
  • Other specialty services
  • HIV prevention and risk reduction education for HIV negative members.

Frequently Asked Questions

Why do I need to know about HIV SNPs?

People living with HIV and AIDS, who qualify for Medicaid managed care and live in New York City, can choose between a regular Medicaid managed care plan or an HIV SNP. It is important to learn about HIV SNPs so you can make the right choices for yourself.

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What is an HIV Special Needs Plan?

An HIV Special Needs Plan (SNP) is a special health plan for people with Medicaid who are living with HIV/AIDS, and their eligible children, whether or not the children have HIV or AIDS.  Homeless individuals who qualify can also choose a SNP even if they do not have HIV. The doctors, nurses, and other care providers who participate in HIV SNPs understand the special needs facing people living with HIV/AIDS.

SNP providers understand that you may need help with:

  • taking medications
  • behavioral health issues including mental health and substance use disorders
  • talking to loved ones about HIV.

If you decide to join an HIV SNP, you choose a SNP primary care provider (a doctor or nurse practitioner) who will take care of most of your health care needs.  If you have HIV, your  primary care providers are "HIV specialists." This means that these doctors and nurses have special training to treat people with HIV/AIDS.
Each plan has its own group of doctors, providers and hospitals. You can choose the plan in which your current doctor belongs, is closest to your home or has the services you need most.

HIV SNPs were created because studies show that when people living with HIV/AIDS get their health care from providers experienced in HIV care, they can live longer, healthier lives.

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What services will I get in an HIV SNP?

You will get all the same services that you get with other Medicaid managed care plans. AND SNPs also cover additional specialty services important to people living with HIV/AIDS.
You will get all the same services covered by Medicaid managed care, such as:

  • doctor visits,
  • physical exams and check-ups,
  • over-the-counter and prescription drugs,
  • hospital care,
  • emergency room services,
  • lab tests,
  • mental health and substance use services.

You may also qualify for additional behavioral health services called Behavioral Health Home and Community Based Services, or BH HCBS.   

What's different with a SNP?

  • Coordinated care from HIV experienced primary care providers (doctors and nurses).
  • Coordinated special services that are important for people living with HIV/AIDS.

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What are some of the special coordinated services?

  • HIV SNP Care Coordination:A Care Coordinator helps put services together to meet your needs. A Care Coordinator can help you make medical and behavioral health appointments and manage your care. An HIV SNP Care Coordinator can help you and your family get counseling, public benefits, substance use disorder  treatment, legal help, and other services.
  • Treatment Adherence Services: People living with HIV/AIDS often take different   medicines and use different treatments. It's important to take medicine correctly to stay as healthy as possible. Treatment adherence services help you to remember and keep track of your medications, manage any side-effects from your medications, and give you advice about new medicines and treatments.
  • HIV Prevention and Risk-Reduction Education: HIV SNPs also give you important education. This education can include counseling, reading materials, and health education classes. This education can help you reduce the chance that you may get new infections or infect others, by letting you know:
    • how to get free male and female condoms;
    • where to get clean needles and syringes, and more important;
    • where to get counseling services to help stop injection drug use;
    • how to talk to your partner about ways to reduce HIV risk and infection, including PrEP and PEP.

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What do SNPs help coordinate?

HIV SNPs are responsible for helping to coordinate:

  • all medical services;
  • services not covered by regular Medicaid, but which support wellness (like, psycho-social case management, housing, counseling, peer support, legal assistance, etc.);
  • special programs for substance abusers, homeless people, and families affected by HIV/AIDS; and
  • services that are "carved out" or paid for through fee for service Medicaid, like long-term care and hospice.

Additionally, all HIV SNPs are required to meet the State Department of Health, AIDS Institute quality standards for HIV/AIDS care.

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Who can join an HIV SNP?

If you are eligible for Medicaid and have tested positive for HIV, you can join one of the HIV SNPs. You can also enroll your eligible children even if your children do not have HIV or AIDS.  Homeless individuals, even if they do not have HIV, may be able to join a SNP to receive the additional specialty services SNPs offer.

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How many HIV SNPs are there?

There are three SNPs in New York City.

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If I join an HIV SNP, can I keep my regular doctor?

YES, if your doctor belongs to the HIV SNP that you choose. This doctor will be your primary care provider. If you want to keep your doctor, ask your doctor if he or she belongs to an HIV Special Needs Plan.

Or call New York Medicaid Choice at 800-505-5678.  Counselors there can tell you what plans work with your doctor and other providers you are seeing now.  Tell the counselor you have questions about joining a Special Needs Plan or SNP. 

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Can I still use the emergency room?

YES. You should go to the emergency room only when there is an emergency. Do not use it for routine care.  Your primary care provider can best treat concerns that are not emergencies. You can get an appointment for an urgent care visit for the same or next day. If you cannot reach your PCP, you can call the SNP for help.

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Do I need to keep my Medicaid card?

YES. You will need your Medicaid Benefit card after you join an HIV SNP. Use your Medicaid card to get  Medicaid services that are not covered using your health plan ID card. Your plan can tell you which services you need your Medicaid card for.

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Do I have to join an HIV SNP?

To receive Medicaid benefits, most individuals must join  a Medicaid managed care plan, including an HIV SNP.   If you do not join a health plan, you will be assigned to a regular health plan and not to an HIV SNP.

If you want to join an HIV SNP you must choose one.

For help selecting the right plan for you, call New York Medicaid Choice at 800-505-5678.  Tell the counselor you have questions about joining a Special Needs Plan or SNP.  Counselors can help you in all languages.

Remember that if you belong to another Medicaid  managed care plan, you can change to an HIV SNP at any time.

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How do I choose which HIV SNP to join?

You should choose an HIV SNP with the doctors, clinics and other special services that are right for you.

To choose an HIV SNP, follow these steps:

  • If you have Medicaid through the New York State of Health, or NYSoH, Marketplace:   
    • You can choose a plan through the Marketplace.  Sign into your account and go to the plan selection page.  You can select a SNP for enrollment yourself. 
      Or you can contact NYSoH Customer Service at 855-355-5777. Tell the counselor you have questions about joining a Special Need Plan or SNP.
  • If you have Medicaid eligibility through HRA:
    • Call New York Medicaid Choice at 800-505-5678 for help selecting the right plan for you.  Tell the counselor you have questions about joining a Special Needs Plan or SNP. 
  • Talk to a HelpLine Counselor:
    •  New York Medicaid Choice   can answer your questions about choosing a doctor and choosing a plan that serves your area. They can send you a packet with enrollment information or assist with enrollment by phone.
    • For help selecting the right plan for you, call New York Medicaid Choice at 800-505-5678.  Tell the counselor you have questions about joining a Special Needs Plan or SNP.  Counselors can help you in all languages.  Everything you say is kept confidential.
  • Talk to your Doctor:
    •  If your doctor is someone you want to keep seeing, make sure to join an HIV SNP that works with your doctor. If you don't have a doctor, New York Medicaid Choice can help you choose a plan that works with health care providers in your area. Call New York Medicaid Choice at 800-505-5678 for help selecting the right plan for you.

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How do I join the HIV SNP I have selected?

  • If you qualify for Medicaid through the New York State of Health Marketplace:
    • You can join a SNP yourself. Sign into your account and pick a SNP on the plan selection page.
    • Or you can call NYSoH customer service at 855-355-5777.  Tell the counselor you want to join a Special Needs Plan, or SNP.  The counselor will assist you with enrolling in a SNP.
  • To enroll by phone:
    • You can join a SNP by calling New York Medicaid Choice, at 800-505-5678. Tell the counselor you have questions about joining a Special Needs Plan or SNP.  Counselors can help you in all languages. 
    • If you are changing from another managed care plan, New York Medicaid Choice can help.
  • To enroll by mail:
    • If you have received enrollment materials, you can fill out and sign the enrollment form. Mail it to New York Medicaid Choice in envelope provided.
  • Or, you can contact the HIV SNP:
    • You can speak to someone at the HIV SNP that you are considering to learn more about how your needs will be taken care of. The SNP can help you  enroll on line or by phone. You can call the Member Services number on the list of HIV SNPs at the top of this page.

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What happens after I enroll?

Keep getting your health care the way you do now until you get a letter saying you  are enrolled in your new HIV SNP.

If you get Medicaid and have tested positive for HIV, think about joining an HIV SNP to get additional specialty care and services.

Once your enrollment is complete, your new plan will need to ask if you are HIV-infected. This information will be kept confidential. 

If you have questions or want to join an HIV SNP, call New York Medicaid Choice, Monday through Friday, 8:30 AM to 8:00 PM; and Saturday 10:00 AM to 6:00 PM at 800-505-5678.

For people with hearing problems, please call the TTY/TDD number, at 888-329-1541.

Your information will be kept confidential.  Help is available in all languages. 

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