Partnership In Care (PIC) HIV
Announcements & plan documents
What are you looking for?
Important Update on Settlement in Consumer Directed Personal Assistance Program (CDPAP)
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.
Important Pharmacy News for our Medicaid, Partnership In Care, and Enhanced Members.
Find a doctor or specialist in your area today
Plan Materials
Starting May 16, 2022, the way Personal Care Services and Consumer Directed Personal Assistance Services (PCS/CDPAS) are initially assessed will be changing. New York State is making this change in the initial assessment process to make it easier to get the services you need.
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.
Core Services Effective 2/1/22
Your Member Handbook has been changed to include additional services
Member Notice
Effective date: June 1, 2025
Member Notice
Effective date: April 1, 2025
Member Notice – Family Planning
Effective: October 2024
Member Notice
Effective date: July 1, 2024
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.
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.
Free or Low-Cost Preventive Health Care Services
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.
IMPORTANT NOTICE TO OUR APPLIED BEHAVIORAL ANALYSIS (ABA) PROVIDERS REGARDING 2023 ABA BENEFIT CHANGES
MetroPlusHealth has been ramping up for the expansion of Applied Behavior Analysis Services to eligible Medicaid members diagnosed with autism spectrum disorder. Services will become available January 1, 2023, for those members under 21 years of age. Learn more here about new benefits and services coming in 2023.
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
January 1, 2019 Member Handbook Insert
July 1, 2019 Member Handbook Insert
October 1, 2019 Member Handbook Insert
October 1, 2019 Infertility Handbook Insert
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.
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!
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.
Pharmacy Network Change
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
