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Public Policy & Activism > Government Insurance & Benefits > SNiP Tips

SNiP Tips View PDF version (requires Adobe Acrobat) On-line Version Table of Contents: 1. Acknowledgements and Foreword 2. An Introduction to HIV Special Needs Plans (HIV SNPs) What are Medicaid health plans? What are HIV SNPs? How are traditional Medicaid, "mainstream" Medicaid health plans, and HIV SNPs different? Does my client have to join an HIV SNP? 3. Who are HIV SNPs for? Who can join an HIV SNP? Does my client need Medicaid to remain in an HIV SNP? Do people with HIV and Medicaid have to join HIV SNPs? Will my client ever be required to enroll in an HIV SNP? 4. How to Enroll How can my client prepare to enroll in an HIV SNP? How does the enrollment process work? How does newborn enrollment work? Can my client appeal decisions about enrollment? 5. Starting Out What information will my client get from the HIV SNP after enrollment? What help can the HIV SNP's member services department give? What kinds of translation and interpretation services are available for my clientswho don't speak English or who have special communication needs? How can my client pick a primary care provider? Can my client keep seeing a non-network provider? How long does my client have to wait to visit HIV SNP providers? 6. Benefits What benefits do HIV SNPs offer? How can my client get specialty care? How can my client get emergency care? What other services can my client get outside the network? How can my client get family planning and reproductive health services? How can my client get mental health and substance abuse services? 7. How to Get Medical and Social Services from the HIV SNP How easy will it be for my client to get medical services? How does the HIV SNP's case management system help enrollees get services? What can my client do if a provider leaves the HIV SNP network? How can my client switch to a different primary care provider? 8. Solving Problems I: Complaints and Appeals How can my client file a complaint? How can my client appeal a plan's decision? What if the plan says a treatment isn't "medically necessary"? 9. Solving Problems II: Fair Hearings What is a fair hearing? When can my client ask for a fair hearing? How does the fair hearing process work? Will my client's disputed benefits be cut off during the fair hearing process? Can my client pursue both an appeal (or utilization review) and a fair hearing? What are the differences between a fair hearing and the appeals (or utilization review) process? 10. Leaving an HIV SNP How can my client leave the HIV SNP when he or she wants to? What can my client do if he or she becomes ineligible for Medicaid? How will my client know when he or she is out of the HIV SNP? 11. Appendix I: Glossary 12. Appendix II: Resources 13. Appendix III: Time Frames for Appointment Availability 14. Appendix IV: Eligible and Excluded Groups 15. Appendix V: Coordination of Services 16. Appendix VI: Access to Mental Health and Substance Abuse Services   © 2005 Gay Men's Health Crisis

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