September 15, 2008

ASC's workshops on HIV managed care are giving consumers the knowledge and tools they need to handle the coming changes at Medicaid.

After five years of voluntary enrollment into HIV Special Needs Plans (SNPs) for HIV-positive Medicaid recipients, the New York State Medicaid Director has announced a plan to implement mandatory managed care enrollment for all Medicaid recipients, including people living with HIV/AIDS. This change has serious implications for people living with HIV/AIDS, and ASC is taking action to respond.

Until now, HIV-positive Medicaid-eligible New Yorkers could access health care in any one of three different ways: Medicaid's fee-for-service program, a mainstream managed care plan (in the form of a traditional HMO), or an HIV SNP (a special type of HMO offering services designed to meet the distinctive needs of people living with HIV/AIDS).

Unfortunately, starting as early as January 2009, people living with HIV/AIDS will see their options narrowed. Medicaid recipients will soon be required to join a managed care plan, be it a SNP or an HMO. Those who don't make a decision quickly enough will be automatically assigned to a mainstream HMO by Medicaid. For many, this will mean losing access to their current physician and specialized HIV medical care.

We anticipate that this change will inadvertently disrupt the health care of many HIV-positive people, separating them from doctors and health care facilities they've come to trust and rely on. Moreover, without a vigorous statewide initiative to education people living with HIV/AIDS about the benefits of SNPs vs. mainstream HMOs, many PLWHAs will wind up getting less than optimal care with potentially devastating results.

Research—including a New York State Department of Health study—shows that people living with HIV who got medical care from an HIV SNP had better outcomes than those receiving care through generic HMOs or fee-for-service providers. SNP patients had the highest rates of prescriptions for antiretroviral medications, the highest rates of consistent viral load measurements, the fewest ER visits, and the highest referral rates for breast cancer screening, cholesterol screening, and dental care.

Given the significance of this data, ASC has launched an education campaign to alert Medicaid-eligible PLWHAs to the coming changes, inform them of the clear benefits of SNPs, and mobilize them to make informed decisions about their health care before Medicaid automatically assigns them to a mainstream HMO. We're now providing English/Spanish bilingual weekly consumer education workshops on HIV managed care options at our Union Square and East Harlem offices. We're also offering this workshop upon request to the clients at any of our sister agencies.

"HIV SNPs are by far the best bet for people living with HIV/AIDS," says ASC Executive Director/CEO Sharen Duke. "Our consumer education workshops inform people about their options, so they're prepared when these changes hit. Our goal is to make sure our community gets the best possible care from clinicians with proven HIV experience. If consumers don't get the information they need to make informed decisions about their medical care, the government is going to make these decisions for them."

For more information about ASC's weekly consumer education workshops on HIV managed care, or to schedule a workshop for the clients at your agency, contact Yelena at: 212-645-0875 x 325 or email: .

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