Special Needs Health Plans Added to the New York State of Health Marketplace
January 1 2016
Beginning on January 15, eligible health care consumers will have the ability to select and enroll in a Special Needs Health Plan (SNP) through the New York State of Health (NYSoH) Marketplace, for the first time since the NYSoH was established in 2012. Consumers will be able to visit the NYSoH website to enroll. SNPs are designed to meet the specialized health care needs of New Yorkers living with HIV or experiencing homelessness and are available to eligible Medicaid members. Amida Care is the largest of the three SNPs in New York State.
SNPs are a linchpin of Governor Andrew Cuomo’s Blueprint to End the AIDS Epidemic (EtE) in New York State by 2020; EtE Blueprint recommendation BP10 calls for adding SNPs to the NYSoH Marketplace. SNPs address the comprehensive medical, behavioral and supportive needs of their members, including lack of stable housing and other social determinant obstacles to care.
“Amida Care thanks Governor Cuomo, the New York State Department of Health Office of Health Exchange Programs, and the New York State AIDS Institute for facilitating this essential step to remove barriers for those who would benefit from enrolling in a SNP over a general Medicaid plan. It will guarantee that people living with HIV/AIDS or who are homeless have better access to options that will connect them with specialized and potentially life-saving care,” said Doug Wirth, President and CEO of Amida Care, who served on the Governor’s Task Force to End the AIDS Epidemic in New York by 2020.
Amida Care was established as a nonprofit SNP in 2003 by several New York City community health organizations that recognized the importance of providing a coordinated model of care to people living with HIV/AIDS. In 2014, people experiencing homelessness, regardless of HIV status, became eligible to enroll in SNPs, which are specifically designed to engage vulnerable individuals in care and provide integrated social support services.
SNPs have proven to be a highly effective model for accessing HIV care, medications, and support services. “We are currently approaching a 75% viral suppression rate among our HIV-positive members. Being added to the NYS of Health Marketplace will enable us to reach more people living with HIV/AIDS so that they benefit from this care model,” Wirth said. Linking and retaining people diagnosed with HIV to health care and treatment helps them become virally suppressed, which is essential to reduce the transmission of HIV, improve health outcomes, and produce long-term cost savings.
“An HIV diagnosis is no longer a death sentence. Antiretroviral therapy and treatment adherence give people living with HIV/AIDS the chance to become virally suppressed so that they live longer, healthier lives and significantly reduce the risk of transmitting HIV to others,” said Dr. Jerry Ernst, Chief Medical Officer of Amida Care. “Making SNP enrollment available on the Marketplace is another critical milestone toward accomplishing the goals of the Blueprint to End the AIDS Epidemic in New York State by 2020.” The Blueprint outlines strategies and plans to reduce the annual number of new HIV infections in New York State from 3,000 to 750 or less by 2020, which would result in an estimated medical cost savings of over $804 million.
In addition to easier plan enrollment for new members, access to SNPs through the Marketplace also enables hundreds of existing SNP members to efficiently resume their enrollment upon recertification, release from correctional facilities, and other membership interruptions.
Amida Care’s SNP provides comprehensive health coverage and coordinated care to people living with multiple chronic conditions, including HIV/AIDS and behavioral health disorders. The plan is also available to Medicaid members who are homeless, regardless of HIV status. The plan offers a wide network of primary care physicians (PCPs) and specialists, as well as close oversight by an integrated care team to ensure that each individual receives the services and personal attention they need to get and stay healthy.
For more information about enrollment on the NYSoH Marketplace, please visit www.nystateofhealth.ny.gov. For more information about HIV SNPs and the services they offer, please visit Amida Care at www.amidacareny.org ; MetroPlus at www.metroplus.org; and VNSNY CHOICE at www.vnsnychoice.org.