Mandatory Medicaid Managed Care Enrollment Begins Sept. 1, 2010 in New York City For People with HIV and AIDS

27 Sep, 2010

As of September 1, 2010, there is no longer an HIV/ AIDS exemption from mandatory Medicaid managed care in New York City.

People living with HIV and AIDS who are Medicaid recipients will be required to join a Medicaid managed care plan if they are not eligible for another exemption (e.g. homelessness) or exclusion (e.g. most dual eligibles).

The Legal Aid Society has recently learned new information about the timeline of the rollout: Individuals who have any action on their cases (such as recertification, address change, etc.) will automatically receive a mandatory enrollment packet and will have to enroll, even if mandatory enrollment has not yet been rolled out in their borough.

The order of rollout across the boroughs is:

Brooklyn,
Bronx,
Manhattan,
Queens,
Staten Island.

After receiving a mandatory enrollment packet, SSI or SSI-related individuals will have 90 days to choose a plan and non-SSI will have 60 days.

However, non-SSI People Living With HIV/AIDS (PLWHA) can request an additional 30 days by calling New York Medicaid CHOICE. This timeline begins after an individual receives a mandatory enrollment packet, even if that borough's rollout has not yet taken place.

For more information on Medicaid Managed Care exemptions, appeals, and other issues, please see:

this article on Medicaid Managed Care
Consumer Fact Sheet -- KNOW YOUR RIGHTS: Medicaid Managed Care in New York State
SDOH Transitional Care Policy - rights of new enrollees in managed care who are receiving an ongoing course of treatment upon enrollment, including those who were receiving certified home health agency care before enrollment.
Medicaid Managed Care Exemption Application Form Updates

Please contact the following if your clients experience any problems related to the rollout of enrollment of people with HIV/AIDS .

Legal Aid Society

Health Law Unit

Helpline: 212-577-3575