NY State of Health Exchange Excludes Medicaid HIV Special Needs Plans

01/12/16 Update:  NYSDOH to add HIV Special Needs Plans to the Exchange January 15, 2016.  More information here: https://nystateofhealth.ny.gov

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Newly enrolled Medicaid recipients residing in New York City must enroll in a Medicaid Managed Care Plan.   To do so online they visit the NY State of Health Exchange.  They then choose from a list of available Plans to join. However, if they are HIV positive and they want to enroll in 1 of 3 unique and specialized Medicaid HIV Special Needs Plans (HIV SNPs) in existence since 2003 and currently serving over 15,000 members, that option is not currently (May 2015) available to them and has not been since the Exchange went live in 2013.  The HIV SNPs are not listed.  Eligible Medicaid recipients can only  join an existing Mainstream Medicaid Managed Care Plan through the Exchange. Once joining a Mainstream Medicaid Plan they cannot transfer to an HIV SNP.  This restriction may also apply to former members of an HIV SNP who were disenrolled due to loss of Medicaid coverage, but upon re-enrollment in Medicaid cannot return to the HIV SNP in which they were previously enrolled.

The State has developed a manual work around but it is not often used because it is cumbersome, time consuming and requires recipients to request provider assistance.

Although the New York State Department of Health has been aware of this problem since the launch of the Exchange, this online enrollment option still remains unavailable (October 2015).

Meanwhile aggregate enrollment in the HIV SNPs continues to decline from its peak membership of 17,072 in 2012 to 14,719 as of September 2015. The HIV SNPs have urged the State to remedy the situation and recently Governor Cuomo’s End the Epidemic Task Force also recommended a resolution in the Task Force Blueprint recommendation BP10 on page 22.  The State recently met with the HIV SNPs and some  steps towards implementation have been taken but no completion date has been established.

Follow this post for additional updates.

12/31/2015 – By mid January 2016 the HIV SNPs are expected to be on the Exchange.   

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