| SNiP Tips
How to Enroll
Joining an HIV SNP is voluntary for now. If a person with HIV decides not to join an
HIV SNP, he or she won't lose Medicaid benefits.
How can my client prepare to enroll in an HIV SNP?
First of all, advise your clients to keep their Medicaid cards. Even
once they join an HIV SNP, they will need the card to get some services, including prescription
drugs and family planning services from any Medicaid provider. (See page 11, "Benefits.")
They might also need their cards to get public benefits, like food stamps.
Also, if your client has a doctor he or she would like to continue seeing, advise him or
her to ask that doctor:
- If he or she participates in the HIV SNP's network;
- The name of the HIV SNP he or she participates in; and
- If he or she can still take new patients through that HIV SNP.
Verify with New York Medicaid Choice what your doctor told you. If the doctor isn't
available through the HIV SNP, your client may want to think twice about joining.
| SNiP Tip: At a minimum, be sure your clients check
with both the doctor and New York Medicaid Choice in New York City to see
if their current doctor has room for new SNP patients. Be aware that sometimes
New York Medicaid Choice will tell your client that a doctor can accept new
patients, when if fact he or she cannot. And sometimes the doctor can take
on patients, even if he or she is officially "full." |
How does the enrollment process work?
Once HIV SNPs are up and running, everyone with Medicaid living in the areas covered by
the HIV SNPs will get a letter about them. The letter will explain what HIV SNPs are and will
tell people that if they have HIV, they and their children can join one. This letter will be
sent to every Medicaid beneficiary. Getting the letter does not mean your
client has HIV.
Your client can call a phone number in the letter to get an enrollment package. Two types
of enrollment packages will be available. People with traditional Medicaid will get information
and an enrollment form for the HIV SNP. Someone already in a Medicaid health plan will get
information, a disenrollment form for the mainstream plan, and an enrollment form for the
HIV SNP.
If more than one SNP is available in your area, your client will be able to pick one on
the enrollment form. In New York City, there will be seven HIV SNPs to choose from. On the
form, your client will need to choose an HIV SNP to enroll in. (See Appendix II, "Resources,"
for a listing.)
Your client might also sign up with a sales marketer from a specific HIV SNP. Advise
your clients that they don't have to sign up this way if they don't want to join or if
they want to get more information from other sources first.
After your client chooses an HIV SNP, he or she should call the SNP to find out what
information they need to verify their HIV infection. The HIV SNP must verify the
client's HIV infection before the enrollment process can be completed. They don't
need to do this for uninfected children or for newborns whose HIV status is still unknown.
Once your client has called the HIV SNP, enrollment materials should be completed and
mailed to New York Medicaid Choice.
| SNiP Tip: Remember, the enrollment will not be completed
until your client's HIV infection has been verified. Contact the member
services department of the chosen HIV SNP to learn how this is done. |
After New York Medicaid Choice processes your client's enrollment materials, the following
notices will come in the mail:
- An initial notification letter, telling your
client about the rights and responsibilities of people in the
HIV SNP
- An enrollment confirmation notice, which gives
the starting date of enrollment, the name of the HIV SNP, and
the names of all family members who are being enrolled
If your client is excluded from joining, she or he will get a notice of denial
of enrollment, which includes information on how to argue against this decision
through a fair hearing. (See page 20, "Solving Problems II: Fair Hearings.")
| SNiP Tip: Advise your clients to keep all written
materials they get if they decide to join an HIV SNP, including all
materials related to enrollment. Tell your clients to use their
enrollment confirmation notice to get care from the SNP until their
membership card arrives. |
How does newborn enrollment work?
Newborn babies who are not in an excluded category (see Appendix IV for complete
listing of eligible and excluded groups) will be automatically enrolled in the
mother's HIV SNP. Enrollment starts the first day of the child's month of birth.
Enrolled pregnant women will want to pick a primary care provider (PCP) for the
baby before the baby is born. If a parent hasn't chosen a PCP for her newborn, the
HIV SNP will assign a PCP to the infant within 2 days of being told of the birth
by the hospital.
Parents can set up an appointment with the infant's PCP right after birth. Within
14 days of finding out about the birth, the HIV SNP has to send a member ID card to
the parents along with a letter confirming the infant's enrollment and explaining
how to get care. A parent can ask for disenrollment of a newborn baby, or of any
child, at any time. (See page 22, "Leaving an HIV SNP.")
SNiP Tip: Your client's decision about whether
to sign up his or her children for the HIV SNP, or keep a newborn
in the plan, can depend on several things. Questions to think
about include:
- Does my client want case management services for his or her HIV-positive
child?
- Is the child's current doctor part of an HIV SNP?
- Parents and HIV-negative children cannot join different SNPs. However, the
HIV-positive parents of HIV-negative children can join a SNP and keep the child
in traditional Medicaid or in a mainstream Medicaid health plan.
|
Can my client appeal decisions about enrollment?
Yes. It's a good idea to check first with whomever your client sent the
enrollment materials to, to see if the problem can be solved easily. In New York
City contact New York Medicaid Choice. If this doesn't fix the problem, your
client can ask for a fair hearing to appeal any decision related to enrollment
and eligibility issues. (See page 20, "Solving Problems II: Fair Hearings.")
For more information about fair hearings, please contact GMHC's Managed Care
Consumer Assistance Program at 212/367-1125; TTY: 212/367-1199. (See Appendix
II, "Resources.")
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