This Work Around provided by the NYSDOH AIDS Institue and shared with Designated AIDS Center Medical and Administrative Directors. It is useful to all NYC HIV Primary Care Providers.
Some of your patients may now qualify for Medicaid and be asked to choose a Managed Care plan. If they enrolled through the Exchange and live in NYC, there has been no option to choose an HIV SNP.
DOH has devised a workaround process to allow enrollment in a SNP The process is not ideal and we suspect requires some help from available navigators and assistors. Please share the referral process outlined below with any support staff who may have been helping with Medicaid any enrollment through the Exchange.
Making it work-HIV Special Needs Plans not a Medicaid plan option on NYSoH Exchange
NYSDOH has outlined a workaround process to allow eligible HIV+ consumers in NYC who qualify for Medicaid to enroll in an HIV SNP. If assisting patients with Medicaid enrollment please review process below. You may want to refer patients to any of the designated navigator agencies you use.
The referral process outline:
· Medicaid eligible SoH consumer contacts the SoH consumer call center ( Toll free 1–855 -355-5777) and identifies their need to enroll in a SNP. Consumers who want to change from a mainstream plan to SNP must follow the same process. Consumer may choose to designate a representative to assist with call center contact.
· SoH Consumer counselor informs consumer of SNP program scope, if consumer indicates the wish to enroll, the counselor creates a system referral.Consumer can identify which SNP during this call. Consumers will not be required to share other confidential information. Counselor will ask for alternate phone number to speed outreach by Medicaid Choice.
· In 5-7 days, the consumer’s case is passed to DOH Coverage and Enrollment staff to have the SoH case closed and a LDSS/WMS case opened. DOH Coverage and Enrollment and NY Medicaid Choice have identified dedicated staff to this process.
· At the same time, DOH staff informs New York Medicaid Choice of impending consumer transfer to WMS system for need of SNP enrollment.Someone from NYMC will call the consumer within 5-7 days to help select the right SNP and to assist with enrollment, or to confirm the plan selected for enrollment and to answer any questions the consumer may have.
· Upon receipt of prospective SNP enrollee, NY Medicaid Choice conducts phone outreach to consumer to educate and confirm plan selection. The plan selection is pended in Medicaid Choice system for WMS case opening. During outreach consumer may choose to designate a representative to assist with phone enrollment process.
· As with all managed care enrollments, the effective date will be based on the enrollment pulldown schedule. Entire process may take 30-60 days.
· Newly enrolled SNP member will receive confirmation notice of enrollment and effective date from Medicaid Choice. Plan ID card and member packet is sent to consumer within 14 days of effective date of enrollment.
AIDS Institute, Office of Medicaid Policy and Programs