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"). An HIV SNP is a health plan that covers 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 an HIV SNP, you will get:
- An HIV Specialist primary care provider
- HIV Care Coordination services
- Information about HIV medications and side-effects
- Treatment adherence services
- Also other special services
Frequently Asked Questions
- Why do I need to know about HIV SNPs?
- What is an HIV Special Needs Plan?
- What services will I get in an HIV SNP?
- What are some of the special coordinated services?
- HIV SNPs are responsible for helping to coordinate what?
- Who can join an HIV SNP?
- How many HIV SNPs are there?
- If I choose to join an HIV SNP, can I keep my regular doctor?
- Can I still use the emergency room?
- Do I need to keep my Medicaid card?
- Do I have to join an HIV SNP?
- How do I choose an HIV SNP?
- HIV SNP Health Plans to Choose From
Beginning in September 2010, people with HIV and AIDS on Medicaid, who live in New York City, will be required to choose between a regular managed care plan or an HIV SNP. If you have Medicare or a "spend-down" you will not be asked to join a health plan. It is important to learn about HIV SNPs now, so you can make the right choices for yourself in the future.
An HIV Special Needs Plan (HIV SNP) is a special health plan for people on Medicaid living with HIV/AIDS and their eligible children, whether or not the children have HIV or AIDS. 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
- alcohol and substance abuse problems
- 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. All HIV SNP 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 one 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 often live longer, healthier lives.
You will get all the same services that you always got with regular Medicaid AND new services important to people living with HIV/AIDS.
- What's the same?
- You will get all the same services you got in regular Medicaid, 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 drug/alcohol abuse services.
- You will get all the same services you got in regular Medicaid, such as:
- What's new?
- Coordinated care from HIV experienced primary care providers (doctors and nurses).
- Coordinated special services that are important for people living with HIV/AIDS.
- HIV SNP Care Coordination: A Care Coordinator helps put services together for you. A Care Coordinator can help you make medical appointments and manage your care. An HIV SNP Care Coordinator can help you and your family get counseling, public benefits, drug treatment, legal help, and other services.
- Treatment Adherence Services: Patients with HIV/AIDS often take many different medicines and use different treatments. It's important to take medicine correctly to keep yourself as healthy as possible. Treatment adherence services help you to remember and keep track of your medications, deal with 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:
- where 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; and
- ways to talk to your partner about HIV risk.
- 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 will be required to meet the State Department of Health, AIDS Institute quality standards for HIV/AIDS care.
If you are on Medicaid and have tested positive for HIV, you can join one of the several HIV SNPs. You can also enroll your eligible children even if your children do not have HIV or AIDS.
There are three SNPs in New York City.
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 and ask if your doctor is in any HIV SNP.
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 problems 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.
YES. You will need your Medicaid Benefit card after you join an HIV SNP. Use your Medicaid card to get your medicine at the drugstore, to see the dentist, and for a few other Medicaid services that may not be covered by your health plan.
Beginning in September 2010, if you have HIV/AIDS and Medicaid and live in New York City you may be required to choose a plan. If you do not join a health plan when asked, 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.
Remember that if you belong to a regular managed care plan, you can change to an HIV SNP at any time. Call New York Medicaid CHOICE at 1-800-505-5678.
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 selection options:
- 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.
- Talk to a HelpLine Counselor
- New York Medicaid CHOICE HelpLine counselors 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. Call the New York Medicaid CHOICE HelpLine at 1-800-505-5678. Everything you say is kept confidential.
- Contact the HIV SNP that you are considering to learn more about how your needs will be taken care of. The SNP can help you complete enrollment forms, or refer you to phone enrollment at New York Medicaid CHOICE. You can call the Member Services number on the list of HIV SNPs to choose from.
- 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 choose a SNP over the telephone by calling New York Medicaid CHOICE HelpLine, at 1-800-505-5678. If you are changing from another managed care plan, New York Medicaid CHOICE can help.
Once your enrollment is complete, the SNP will need to ask if you are HIV-infected. This information will be kept confidential. Keep getting your health care the way you do now until you get a letter that tells you when you are enrolled in the HIV SNP.
If you get Medicaid and have tested positive for HIV, think about joining an HIV SNP.
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 1-800-505-5678. For people with hearing problems, please call the TTY/TDD number, which is 1-888-329-1541.