Partnership In Care (PIC)HIV Special Needs Plan
HIV Special Needs Plan
Compassionate, Coordinated HIV Care — Ranked #1 in Quality in New York State
*Ranking based upon the NYS DOH Quality Incentive results for HIV Special Needs Plan (SNP) Managed Care plans.
MetroPlusHealth’s Partnership in Care (PIC) HIV Special Needs Plan (SNP) offers compassionate, team-based care for New Yorkers living with HIV/AIDS and related conditions. Ranked #1 in Quality in New York State for three years in a row (2021–2023), the PIC Plan delivers exceptional HIV healthcare with comprehensive medical services, prescription coverage, behavioral health support, and wellness resources. Our dedicated network of providers helps members achieve better health and lead more fulfilling lives.
Partnership in Care (PIC) Provides a Team Approach to Caring for People Living with HIV/AIDS and Other Select Groups.
The Health and Wellness team includes an HIV Specialist as your primary care provider (PCP). Our Care Managers help you make appointments and stay on top of your medications. We can make it easier to see specialty providers, such as Hepatitis C experts, dermatologists, and heart specialists. Our team of experienced clinicians can also help you and your family to get drug treatment or support services, like counseling, public benefits, legal help, and other services.
MetroPlusHealth Partnership in Care (PIC) Special Needs Plan (SNP) is open to most Medicaid-eligible adults and children living with HIV/AIDS in New York City. Children (up to age 21) of Partnership in Care members are also eligible to enroll, even if they are HIV-negative. Homeless residents of New York City may also be able to enroll.
If you live in New York City, are on Medicaid, and are receiving care for transgender health, you may also be eligible to enroll. Your children may also qualify to enroll in the SNP. Learn more in the Plan Materials section below.
Member Rewards Program for MetroPlusHeaalth’s Partners in Care (PIC) HIV members.
Earn rewards for making healthy choices!
What does Partnership in Care (PIC) provide?
Coordinated care with an HIV specialist as your primary care provider (PCP)
A dedicated Health and Wellness Advisor to provide medical case management and care coordination services in consultation with your PCP
HIV primary and secondary prevention and risk reduction education and counseling
Harm reduction education and services
HIV treatment adherence services
Care advocacy services
Behavioral health and mental health services
You also receive all the benefits of Medicaid:
Prescriptions, including hormone therapy or hepatitis B and/or C treatment, if needed
Specialist care
Lab, x-rays, and other tests
Inpatient and outpatient hospital care
Nutritional assessment and guidance
Maternity and childcare, including care for children regardless of HIV status
Home care services
Personal care / home attendant services
Mental health and substance use disorder services
Dental care and vision care benefits
Adult day care and AIDS adult day health care
Hospice
Nursing home
Transportation to medical appointments*
* This benefit is coordinated by MAS for New York State Medicaid members; call 1-844-666-6272.
In addition, our HARP-eligible members are eligible for Behavioral Health (BH) Home and Community Based Services (HCBS). For more information, click here.
DID YOU KNOW? There are many supports and services available to the LGBTQI community here in New York City. Learn more about where you can find help in our LGBTQI Resource Guide below.
Plan Materials
Your Member Handbook tells you about your covered benefits and services as defined by federal and New York State Medicaid laws and regulations. Learn about:
- limitations
- eligibility
- network providers
- how to access health care services
- your rights and responsibilities.
Benefits
MetroPlusHealth Partnership in Care (PIC) (HIV SNP) plan provides services covered in the Medicaid benefits package. In addition, PIC members receive coordinated care by an HIV specialist as their primary care provider (PCP), HIV case management/care coordination, HIV treatment adherence services, and HIV Primary and Secondary Prevention and Risk Reduction services.
Dental Services – Medicaid, PIC, HARP
Starting January 31, 2024, MetroPlusHealth will be covering crowns and root canals in certain circumstances so that you can keep more of your natural teeth.
Starting March 1, 2024, MetroPlusHealth will cover the Mobile Crisis Telephonic Triage and Response service for members under the age of 21. This service is already available to members 21 years of age and older.
Handbook Inserts
Member Notice
Effective date: June 1, 2025
Member Notice
Effective date: April 1, 2025
Member Notice – Family Planning
Effective: October 2024
Core Services Effective 2/1/22
January 1, 2021 Member Notice
December 1, 2020 Member Handbook Insert
June 1, 2020 Member Handbook Insert
April 1, 2020 Member Handbook Insert
February 1, 2020 Member Handbook Insert
January 1, 2020 Member Handbook Insert
Additional Resources
If you live in New York City, are on Medicaid, and are receiving care for transgender health, you may also be eligible to enroll. Your children may also qualify to enroll in the SNP. Learn more below.
At MetroPlusHealth, we always want you to be at your best. That’s why we encourage you and your family to take advantage of preventive care services available to you at low or no cost. We’ve listed dozens of FREE preventive services here for adults, women and children that just may help you be your healthiest yet.
Rx Carve-Out
Beginning April 1, 2023, all Medicaid members enrolled in MetroPlusHealth Medicaid, Partnership In Care, and Enhanced (HARP) plans will receive their prescription drugs through NYRx, the Medicaid Pharmacy Program.
Information about the transition of the pharmacy benefit from MetroPlusHealth to NYRx, the Medicaid Pharmacy Program can be found here.
General information about NYRx, the Medicaid Pharmacy Program can be found here along with information for Members and Providers.
How do I enroll?
Enrollment in our HIV SNP is available all year through the Marketplace for qualified individuals. Visit nystateofhealth.ny.gov/.
If you would like help signing up, contact MetroPlusHealth at 1.855.809.4073 (TTY: 711).
Questions? Ready to sign-up?
Our Member Services team is always here to help. We are here Monday through Saturday from 8:00AM to 8:00PM. Just call 1.800.303.9626 (TTY:711).
Our 24/7 Customer Service Hotline will answer your call at other times and on holidays.
Medicare members can call us 24/7 at 1.866.986.0356 (TTY: 711).
If you are experiencing a mental health crisis, our Behavioral Health Crisis after hours partner — Vibrant Emotional Health — can be reached 24/7 at 1.866.728.1885 (SMS capable for the hearing impaired).
Language assistance services and other aids, free of charge, are available to you.
Comprehensive Guidance Regarding Use of Telehealth including Telephonic Services After the Coronavirus Disease 2019 Public Health Emergency
Comprehensive updated guidance regarding use of telehealth (including telephonic services) and billing guidance and criteria following the end of the Coronavirus Disease 2019 Public Health Emergency, released by the New York State Department of Health.
NON-EMERGENCY TRANSPORTATION BENEFIT:
Your non-emergency transportation benefit is provided by Medical Answering Services (MAS). Need to schedule a ride?
Call 844-666-6270 or Schedule Online!
Resources to Help You Manage Your Plan
Complaints and Appeals
We hope our health plan serves you well. But if you have a problem, you can talk with your PCP, or call or write our Member Services. Most problems can be solved right away. If you have a problem or dispute with your care or services, you can file a complaint with us. Problems that are not solved right away over the phone — and any complaint that comes in the mail — will be handled according to our complaint procedure described here.
Did you know?
If you are turning 65 within the next 3 months or you are 65 years of age or older, you may be entitled to additional medical benefits through the Medicare program. Learn more here. If you have questions, please call Customer Services team at 1-800-303-9626. If you have Medicaid, you MUST apply for Medicare as a condition of continuing eligibility.
You can apply for Medicare by calling the Social Security Administration at 1-800-772-1213 or by applying on-line at: https://www.ssa.gov/medicare/. You may be required to submit proof that you have applied for Medicare so please keep your award or denial letter from SSA or your on line receipt from SSA.
If you have more questions, please call our Customer Services team at 1-800-303-9626.
Access to a doctor—whenever and wherever you need it!
MetroPlusHealth Virtual Visit is the fast, easy way for our members to see a provider for common physical, mental, emotional, and behavioral health issues that are not emergencies. MetroPlusHealth Virtual Visit is available anytime, from anywhere in New York State, 24/7 – and in your language.
Know your rights and protections against surprise medical bills!
When you get emergency care or are treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from balance billing. In these cases, you shouldn’t be charged more than your plan’s copayments, coinsurance and/or deductible.
Are you receiving care at an NYC Health + Hospitals facility?
Manage your health online with MyChart. Members who receive care at NYC Health + Hospital facilities now have access to MyChart. MyChart is a free secure portal you can use to manage your health information. MyChart allows you to:
- Message your primary care provider’s office
- Request refills of your prescription drugs
- Access your test results
- Schedule appointments
