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Partnership In Care (PIC) HIV

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

Now available on Staten Island!

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.

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.

Medicaid, PIC, HARP, CHP:

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!

Important Pharmacy News for our Medicaid, Partnership In Care, and Enhanced Members.

YOUR MEMBER HANDBOOK HAS BEEN CHANGED TO INCLUDE ADDITIONAL 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.

Mobile Crisis Telephonic Triage Response Service

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.

 

Member and Provider FAQs - Pharmacy Benefit Carve-Out

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).

Free or Low-Cost Preventive Health Care Services

Preventive Health Care Guidelines

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.

Free or Low-Cost Preventive Health Care Services

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

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.

Member Guide for Partnership in Care (PIC)
NYS Standard Form to Designate a Representative to Assist with Health Insurance Authorizations, Complaints, Grievances, and Appeals

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.

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.

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.

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 Rx Customer Services Team at 1-(855) 656-0361 for Child Health Plus members or 1-(855) 383-9426 for Exchange Plan members.

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MetroPlusHealth Virtual Visit

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.

GREAT NEWS: STARTING JANUARY 1, 2023, METROPLUSHEALTH MEMBERS WILL RECEIVE THEIR DENTAL BENEFITS FROM DENTAQUEST.

Recently, we sent you an announcement along with your new ID Card about our new partnership with DentaQuest, a dental vendor. Starting January 1, 2023, you can begin to use your new ID Card for all your health care needs, including dental services with DentaQuest. Remember to bring your new ID card when you visit your dentist.

Your oral health is important to us. Partnering with DentaQuest, we are able to bring their experience and passion for improving oral health care to you. Their dental network is 65% larger than what we have been offering, with more dentists and specialists available than before. Learn more about your new dental benefit here.

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.

Explore all MetroPlusHealth Plans

last updated: May 13, 2024

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