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Partnership In Care (PIC) HIV - SNP

Partnership in Care (PIC) provides a team approach to caring for people living with HIV/AIDS and other select groups.

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.

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

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 SNP 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.

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).

Speak to MetroPlusHealth

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).

Important Message To Our Members Regarding Core Services

Effective February 1, 2022, in order to improve access to services, NYS is transitioning four BH HCBS to a new service array called Community Oriented Recovery and Empowerment (CORE) Services. These four services include Community Psychiatric Support and Treatment (CPST), Psychosocial Rehabilitation (PSR), Family Support and Training (FST), and Empowerment Services – Peer Support (Peer Support). BH HCBS Short-term and Intensive Crisis Respite services will be transitioned to Crisis Intervention Benefit Crisis Residence services, already available to all adult Medicaid Managed Care enrollees. All other existing BH HCBS will remain available as BH HCBS with previously established requirements, workflows, and processes.

CORE services are specialty services that can help people meet their recovery goals, like getting help with finding a job or going to school, or living more independently.

For members who are 21 or older, covered by Medicaid, and enrolled in a Health and Recovery Program (HARP), CORE services may be just right. Additionally, some individuals enrolled in HIV-Special Needs Plans or Medicaid Advantage Plus Plans will be eligible for CORE. CORE services are covered by health insurance, at no cost to our members.

Learn more about CORE services below. Questions about CORE services? Call us at 1-800-303-9626 or speak with your behavioral health provider.

Effective January 1, 2019, new mental health and substance use services are available with NYS Children’s Medicaid. These services give children/youth (under age 21) and their families the power to improve their health, well-being and quality of life, strengthening families and helping them make informed decisions about their care. Services are provided at home or in the community. Learn more here.

IMPORTANT NOTICE TO OUR MEDICAID MEMBERS: Announcing a New Foster Care Transition to Medicaid Managed Care- Special Population

Starting July 1, 2021, MetroPlusHealth will cover Article 29-I Voluntary Foster Care Agency (VFCA) Health Facility services for children and youths under age 21 in foster care and other special populations, as indicated.

Also starting July 1, 2021, some children and youth must join a Medicaid managed care plan, including:

  • children and youth placed in foster care in New York City, and
  • children and youth placed in foster care and a 29-I VFCA Health Facility

Some children and youth placed in foster care cannot join a Medicaid managed care plan. They will keep getting services through regular Medicaid.

CORE Member Brochure

Important Message to Our Members:  Earn $100 in reward points for getting your COVID-19 vaccine!

Members age 12+ who are in our MedicaidSNP-HIV, or HARP plans who get all required doses on or after 11/01/2021 earn 1,000 reward points ($100 value)!

Visit MetroPlusHealth Rewards to let us know you have completed your vaccinations, or call us at 1-800-510-3944 (TTY: 1-844-488-9723) Monday-Friday 8 a.m. to 8 p.m. ET and you will earn your reward points instantly. Then, shop hundreds of items in the MetroPlusHealth Rewards Catalog!

Get a COVID-19 vaccine now and earn rewards!

Important Notice: Effective October 1, 2021, our members now access their behavioral health services through MetroPlusHealth. Learn more here.

IMPORTANT NOTICE TO OUR PARTNERSHIP IN CARE MEMBERS 18 YEARS AND OLDER

MetroPlusHeath is proud to offer benefits and services that help you live a healthy life. Starting July 1, 2022, you can join a no-cost Medically Tailored Meals program that provides healthy meals straight to your home.

Through this program, you and other members who qualify can get:

  • Help from a registered dietitian and nutritionist. This person is a food and nutrition expert and will help give guidance and support in choosing healthy foods.

Up to three meals per day delivered to your home for six months at a time. You may be able to continue receiving meals as long as you are eligible for this program. These meals are tailored for your specific health needs and can help you gain access to healthy, nutritious foods. Learn more below.

Plan Materials 

Important Notice to Our Partnership In Care Members 18 Years and Older:

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.

Transgender Health 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.

Guide for Partnership in Care (PIC)

Important Notice for Our Partnership In Care Members:

You may have recently received a notice telling you that effective October 1, 2021, MetroPlusHealth will begin to cover Applied Behavior Analysis for eligible members under the age of 21.  New York State has decided that this benefit will be covered by Medicaid Fee-For-Service not by MetroPlusHealth.  On October 1, 2021, if eligible, you will still be able to receive these services, but you will have to use your Medicaid card.

Physical Therapy (PT), Occupational Therapy (OT), and Speech Therapy (ST)

January 1, 2021 Member Notice

Crisis Residence Services

December 1, 2020 Member Handbook Insert

Contraceptives

June 1, 2020 Member Handbook Insert

Maximum Copay Change

April 1, 2020 Member Handbook Insert

National Diabetes Prevention Program

February 1, 2020 Member Handbook Insert

Children’s Family Treatment and Support Services: Crisis Intervention and Youth Peer Support and Training

January 1, 2020 Member Handbook Insert

Children’s Family Treatment and Support Services

January 1, 2019 Member Handbook Insert

Children's Behavioral Health Services

July 1, 2019 Member Handbook Insert

If you would like a hard copy of this handbook, you can submit a request online here or call us at 1-800-303-9626 (TTY: 711). Please be sure to tell us which plan handbook – for example, Partnership in Care (PIC) – you need.

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.

Important Update

Pharmacy Network Change

Starting January 1, 2022, Walgreens and Duane Reade will no longer be in the pharmacy network for members of these plans:

  • Medicaid Managed Care (including Partnership in Care and HARP Plans)
  • Child Health Plus
  • Exchange / MarketPlace Plans

Where can I find a list of participating network pharmacies?

Members can find a list of network pharmacies or use our online provider search tool.

What do I do if I get my medications from Walgreens or Duane Reade?

Members who have an ongoing prescription including medications, certain supplies such as pen needles, test strips, continuous glucose monitors, and blood glucose test strips at a Walgreens or Duane Reade should call their health care providers to get a new prescription to be sent to a different pharmacy.

Who can I call if I have questions?

If you have any questions, please call the CVS Caremark® Customer Care Team at 1-(855) 656-0361 for Medicaid Managed Care and Child Health Plus members or 1-(855) 383-9426 for Exchange Plan members.

Looking for a pharmacy with free delivery?Looking to get your medications sent to you pre-packaged? Want a pharmacy that you can text?

MetroPlusHealth has partnered with Medly Pharmacy to offer free delivery and more! Sign up here or call Medly at (929) 454-5090.

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MetroPlusHealth Virtual Visit

Access to your 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
Preventive Services Resources

Learn about all of the free preventive services for adults, women and children. Preventive care includes immunizations, physical exams, lab tests and prescriptions. If you have any questions, call one of our Member Services Representatives. We’re here to help.

Health Risk Assessment 

HRA can be returned to:
ATTENTION: QM Health Risk Assessment Unit
MetroPlus Health Plan
50 Water Street, 7th Floor
​New York, NY 10004
or by completing our Contact form by clicking here.

IMPORTANT INFORMATION: MONKEYPOX CASES ARE RISING IN NYC.

Monkeypox cases are rising in NYC. Learn more about Monkeypox, including prevention and treatment, here.

last updated: June 3, 2022

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