In anticipation of the auto-assigment of HIV positive beneficiaries in Brooklyn to mainstream plans I asked my sources at Medicaid CHOICE to explain how the process will work. Here’s a summary of the response I received:

Brooklyn
Non SSI consumers will be auto-assigned in November for a December 1st, 2010 effective date, if they did not make a plan choice, request an exemption or an extension.

SSI consumers will be auto-assigned in December for a January 1st, 2011 effective date, if they did not choose a plan or request an exemption.

Once an HIV consumer is auto-assigned, they have 90 days to transfer into any plan (mainstream or SNP). After the 90 day grace period, they are locked into the plan and may only transfer into a SNP (unless they have a good cause reason to transfer into a mainstream).

HIV consumers will only be auto-assigned into a mainstream plan.

Consumers in Plans may transfer into a SNPby calling New York Medicaid CHOICE and the transfer will be effective the 1st of the following month.

Bronx
Bronx notices are expected to be sent beginning November 2010.

New York Medicaid CHOICE
New York Medicaid CHOICE has a toll-free Consumer Help Line that is open Mon – Fri 8:30 AM to 8:00 PM and Saturdays 10:00 AM to 6:00 PM. Consumers can call 1-800-505-5678 for questions about Medicaid managed care and to arrange for individual counseling or to find out where the nearest group presentation is held.

Valuable information about Medicaid Managed Care in New York City can be found on the New York City Department of Health and Mental Hygiene website here:  http://www.nyc.gov/html/doh/html/hca/hca1.shtml

The quickest way to enroll in a New York City HIV Special Needs Plan (SNP) is to call Medicaid CHOICE (1-800-505-5678). For people with hearing problems, please call the TTY/TDD number, which is 1-888-329-1541.

Medicaid CHOICE accepts calls:

• Monday – Friday 8:30 am to 8:00 pm
• Saturday 10:00 am to 6:00 pm

Operators are available who can speak English, Spanish, Haitian Creole, Chinese, Russian and also other languages upon request. Here are some tips to get done quickly:

• Have your Medicaid number on hand.
• The counselor will ask you for your Medicaid number and tell you if you are eligible to enroll in a Plan.
• If you know which SNP you want to join, tell the counselor your choice.
• If you don’t know what SNP your doctor/provider is in then the counselor can look them up and tell you. The counselor can tell you about all the SNPs and the Managed Care Plans serving your borough. The counselor cannot choose a SNP or Plan for you.
• If you do not have a doctor/provider then decide in which borough you would like to receive your care and the counselor will assist you in identifying available providers in each SNP.
• If you are eligible the counselor will tell you the date you will be enrolled.
• Once you select a SNP the counselor, after gathering some basic information from you, will connect you to the SNP member services staff so you can talk to them.

The call can take 20-40 minutes.

Remember during mandatory enrollment

“To have a choice you must make a choice!”