| SNiP Tips
Leaving an HIV SNP
How can my client leave the HIV SNP when he or she wants to?
HIV SNP enrollees can decide to disenroll at any
time. By disenrolling, they can switch to traditional (fee-for-service)
Medicaid, a mainstream Medicaid health plan, or another HIV SNP.
Disenrollment normally happens the first day of the month after
the request. But people in HIV SNPs can request an expedited
disenrollment, which is faster. Expedited disenrollment
requests must be processed within seven days. Adverse decisions
about disenrollment can be appealed through the fair hearing process.
(See page 20, "Solving Problems II: Fair Hearings.")
To disenroll within New York City, enrollees can call New York Medicaid Choice
at 1-800-505-5678. Outside of New York City, they can call the local Medicaid
office. If your client experiences problems disenrolling, call GMHC's Managed
Care Consumer Assistance Program at 212/367-1125; TTY: 212/367-1199.
| SNiP Tip: Advise your clients to think about how their
leaving the plan will affect their children's membership. Parents and guardians
are advised to disenroll non-HIV-infected children when they leave the plan.
If the parent or guardian dies, non-HIV-infected children are disenrolled at
recertification. In both cases, HIV-positive children can remain in the plan.
Remember, a parent can disenroll their newborn baby or child without leaving
the plan themselves.
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What can my client do if he or she becomes ineligible for Medicaid?
The HIV SNP can disenroll members for a number of reasons:
- The enrollee is not Medicaid-eligible anymore;
- The enrollee meets the exclusion criteria for HIV SNPs (see page 3, "Who
HIV SNPs are for"); or
- The enrollee hasn't come for treatment or case management appointments for
a period of three months after joining, or for a period of six months once a
treatment program has been started.
If a beneficiary is disenrolled from the plan because of losing Medicaid
eligibility and then becomes eligible again within three months, she or he
will be automatically re-enrolled in the HIV SNP, if the HIV SNP has room.
| SNiP Tip: SNiP Tip: If your client is disenrolled from
the HIV SNP because he or she has lost Medicaid eligibility, you may need to
help him or her apply for other sources of health coverage, like New York
State's AIDS Drugs Assistance Program. Contact GMHC at 212/367-1225; TTY:
212/367-1199 for advice.
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How will my client know when he or she is out of the HIV SNP?
After your client has disenrolled from the HIV SNP, New York Medicaid Choice
will send the enrollee a notice of disenrollment including the date of disenrollment.
New York Medicaid Choice also has to send notices if the enrollee's Medicaid
coverage is ending and/or if the enrollee's eligibility for the HIV SNP is ending.
| SNiP Tip: When a person is disenrolled for any reason, the
HIV SNP has to give a discharge plan (see Glossary) to the person and the PCP
within 15 days of the request for or notice of disenrollment. This plan has to
say how the person will get care during the transition. Advise your clients to
call member services if they don't get this plan within 15 days.
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