How does Medicaid managed care change the way HIV+ individuals get their Medicaid benefits?
HIV+ individuals have the same Medicaid benefits regardless of whether they are in Medicaid managed care or regular Medicaid. The main difference is that managed care members get most of their Medicaid benefits from the health plan’s network of providers, hospitals, physicians, and clinics. Managed care plan members receive a health plan identification card and also keep their Medicaid card to receive certain benefits through regular Medicaid. These benefits, which are referred to as “carved out benefits,” include but are not limited to: prescriptions; certain HIV related labs tests; COBRA case management; AIDS adult day health care (ADHC); methadone maintenance treatment programs (MMTP) and selected substance abuse treatment and mental health services. The delivery of certain benefits like mental health and dental services may be different in HIV Special Needs Plans than in mainstream managed care. All managed care plan members can get emergency services from any qualified provider.
