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.

Updated on: June 16,2005

When you join an HIV SNP, you will get:

  • An HIV Specialist primary care provider
  • HIV case management
  • 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?

Joining an HIV SNP is voluntary. In the future, people with HIV and AIDS on Medicaid may have to choose between a regular managed care plan or an HIV SNP. It is important to learn about HIV SNPs now, so you can make the right choices for yourself in the future.

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What is an HIV Special Needs Plan?

An HIV Special Needs Plan (HIV SNP) is a special health plan for people on Medicaid living with HIV/AIDS and their children up to age 19, 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.

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What services will I get in an HIV SNP?

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.
  • What's new?
    • Coordinated care from primary care providers (doctors and nurses) who are HIV specialists.
    • 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 Case Management: A case manager helps put services together for you. A case manager can help you and your family get counseling, public benefits, drug treatment, legal help, and other services. A case manager can help you make medical appointments and manage your care.
  • 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.

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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 will be 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 on Medicaid and have tested positive for HIV, you can join one of the several HIV SNPs. You can also enroll your children (up to age 19) even if your children do not have HIV or AIDS.

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

YES, if your doctor belongs to the HIV SNP that you choose. 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.

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Can I still use the emergency room?

YES. You should go to the emergency room only when there is a real emergency. Do not use it for routine care. Your primary care provider can treat problems that are not emergencies.

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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 your medicine at the drugstore and for other Medicaid services that may not be covered by your health plan.

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Do I have to join an HIV SNP?

NO. Right now if you have HIV/AIDS you do not have to join any health plan. If you do not join a health plan, you will keep getting health care the way you do now. However, in the future this may change, and you may have to choose either a regular Medicaid health plan or an HIV SNP.

Remember that if you belong to a regular managed care plan, you can change to an HIV SNP at any time. If you enroll in an HIV SNP you can disenroll at any time. Just call New York Medicaid CHOICE at 1-800-505-5678.

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How do I choose an HIV SNP?

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:

  • 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 also send you a packet with enrollment information. 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.
  • Fill out and sign the enrollment forms
    • Mail the forms to New York Medicaid CHOICE or return forms to the SNP you choose. 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.
    • Before your enrollment is complete, the plan will need to ask if you are HIV-infected. This information will be kept confidential.
    • If you are transferring from another managed care plan, you must fill out an enrollment form and disenroll from the other plan. Call New York Medicaid CHOICE and ask for a transfer packet or contact the SNP to ask what you need to do.

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 (choose Option #4 - HIV Special Needs Plan). For people with hearing problems, please call the TTY/TDD number, which is 1-888-329-1541.

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