Health Care Services

Uninsured Care Programs

ADAP, ADAP Plus, HIV Home Care, ADAP Plus Insurance Continuation, Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)

The New York State Uninsured Care Programs (UCP) include program components for New Yorkers at risk for and living with HIV who are uninsured or underinsured:

  • The AIDS Drug Assistance Program (ADAP) provides life-saving medications, with a formulary of more than 500 medications. Coverage of drugs and services is revised based on available funding and the changing clinical profile of the epidemic.
  • ADAP Plus provides HIV primary care services.
  • The ADAP Plus Insurance Continuation (APIC) program provides assistance in paying health insurance premiums to support access to comprehensive health care coverage in a cost-effective manner.
  • The Home Care Program provides care in the home.
  • The Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) provides access to primary care services and monitoring to support the use of Pre-Exposure Prophylaxis (PrEP) to prevent HIV.

The programs serve New York State residents who are HIV positive or at risk of acquiring HIV and are uninsured or under-insured and meet established residency, financial, and medical criteria.  The programs serve as a transition to Medicaid by providing interim assistance to individuals eligible for but not yet enrolled in Medicaid, or assistance in meeting spend-down requirements.  Individuals with third-party insurance who cannot meet the deductibles or co-payments are eligible to enroll in the programs.  Adolescents who do not have access to the financial or insurance resources of their parents/guardians are also eligible.

Linking people with HIV to treatment to improve health and achieve viral suppression is a primary goal of the AIDS Institute, a key goal of the Integrated Plan/SCSN, and one of the fundamental tenets of New York State’s ETE initiative.  The UCP ensure universal access to care and treatment that are essential to improve health outcomes, achieve viral suppression, and reduce the risk of transmission.  The UCP address gaps in and barriers to care and improve outcomes along the continuum, including linkage to care and viral suppression. The UCP are key components in New York’s response to the HIV/AIDS epidemic. 

In 2019, the regulations governing the UCP were modified to increase the income limit and eliminate the assets test, expanding eligibility for the programs.  In addition, acknowledging the critical need for rapid access to ARV therapy, the UCP revised the enrollment process to facilitate same-day enrollment and rapid access to treatment. 

The UCP has implemented an on-line portal that allows secure submission of program applications and recertification documents. The on-line process will further streamline  enrollment and recertification processes and will support rapid access to treatment for persons living with HIV by allowing applicants to securely complete and submit the application and supporting documentation (medical form, income and residency verification, etc.) for initial application and recertification documentation as needed.

The programs serve all populations affected by HIV in New York State and serve more than 25,000 uninsured and underinsured persons living with HIV/AIDS annually. The majority of ADAP participants are persons of color: 38.4 percent are Black; 35.3 percent are Hispanic; 22 percent are White; three percent are Asian/Pacific Islander/Native American. New York State's ADAP/ADAP Plus has the most comprehensive drug and service coverage of any state in the country.

Contact:

Julie Vara
Director, Office of Uninsured Care Programs
518-459-1641 or 1-800-542-2437 (In New York State Only)
julie.vara@health.ny.gov

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AIDS Nursing Facilities

Skilled Nursing Facilities providing services to residents living with HIV/AIDS must ensure special services are provided including: medical services by a physician who has experience in the care and clinical management of persons living with HIV/AIDS; sub-specialty physician services; nursing services supervised by a registered professional nurse with experience in the care and management of persons living with HIV/AIDS; substance abuse services; HIV risk/harm reduction education; comprehensive case management; and pastoral care.

There are 11 facilities with the distinct AIDS Nursing Facility licensure designation (denoting a number of beds exclusively designated for people with an AIDS defining diagnosis) with a total of 854 beds, located primarily in New York City. One facility is in Nassau County.   

An additional 13 facilities across New York State are approved for AIDS scatter beds.  These facilities have the ability to admit up to ten residents living with HIV/AIDS at any point in time. The AIDS Institute will continue to monitor the need for AIDS nursing home beds and will encourage the development of AIDS Scatter beds in nursing facilities in Upstate New York as necessary to ensure sufficient access to nursing home care for persons with HIV/AIDS. 

Contact:

Harrison Moss, MPH, MCHES
Coordinator, Acute & Chronic HIV Care Programs
Office of Medicaid Policy and Health Care Financing
518-486-1383
Harrison.Moss@health.ny.gov

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AIDS Adult Day Health Care Programs

AIDS Adult Day Health Care Programs (ADHCPs) provide a comprehensive range of services in a community-based, non-institutional setting to persons living with HIV or at high risk for HIV.  General medical care is provided, and treatment adherence support, nursing care, rehabilitative services, nutritional services, case management, HIV risk reduction, substance use, and mental health services are among the services provided.  Health maintenance/wellness activities such as supervised exercise and structured socialization are adjunct components of the program model but cannot be the sole reason for admission/continued stay in the program.

The intent of the ADHCPs is to complement or enhance the continuum of medical services through on-going coordination with primary care providers and other service providers. ADHCPs are designed to provide a comprehensive and integrated model of service delivery in a cost-effective manner by avoiding duplication of services and minimizing the need for patients to receive additional off-site services. Treatment adherence is often compromised by commonly occurring co-morbidities of substance use, mental illness, and other chronic conditions. This comprehensive care model has evolved over time to address the challenges of aging and the complexity of managing multiple comorbidities. 

ADHCP services are located in the Greater New York Metropolitan area. Currently, there are 8 licensed programs with a capacity to serve 637 clients per day.

Contact:

David Gabrielsen
Health Program Coordinator
Office of Medicaid Policy and Health Care Financing
518-486-1383
David.Gabrielsen@health.ny.gov

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Retention and Adherence Programs (RAP) in Medical Settings

The Retention and Adherence Program (RAP) provides a framework for continuous HIV/AIDS treatment and care in a medical setting and is designed to increase the number of People Living with HIV/AIDS (PLWHA) that are adherent to antiretroviral therapy (ART), thereby diminishing viral load, improving quality of life, and reducing the ability to transmit the virus to others. Grant funds support RAP services in a range of settings throughout New York State, including Community Health Centers and hospital ambulatory clinics.

RAP focuses on two groups of patients: individuals who are newly diagnosed; and individuals who have been unable to achieve sustained viral suppression.

The intent of RAP is to facilitate rapid access to HIV treatment, including immediate initiation of antiretroviral treatment after HIV diagnosis, and provide services that support PLWHA in achieving viral load suppression. The program seeks to address the individual barriers preventing some PLWHA from engaging and adhering to HIV treatment. The RAP is a vital part of the clinical model. A multi-disciplinary team approach is used to provide support to the patient in implementing and sustaining their clinical treatment plan. Interventions are intensive and highly individualized. The support provided increases the ability of the patient to improve personal health outcomes, with the goal of patient self-management.

Contacts:

Janice Bigler
Initiative Director
Bureau of HIV Ambulatory Care Services
Janice.bigler@health.ny.gov

Jill Dingle
Initiative Director
Bureau of HIV Ambulatory Care Services
jill.dingle@health.ny.gov

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Designated AIDS Centers

Designated AIDS Centers (DACs) are State-certified, hospital-based programs that serve as hubs for a continuum of hospital and community-based care for persons with HIV and AIDS.  AIDS Centers provide state-of-the-art, multi-disciplinary inpatient and outpatient care coordinated through hospital-based case management.  DACs with pediatric and obstetrical departments also provide specialized HIV care to infants, children, and pregnant women.

The AIDS Center program was developed and remains a patient-centered program model that can evolve with the needs of the patient in the changing health care environment.  AIDS Centers provide a primary care home for the person with HIV.  Patient outcomes improve when care is seamless, coordinated by a care manager utilizing multi-agency, multi-disciplinary health care teams.

HIV-specific care standards developed for DACs are intended to ensure uniformly high quality care for HIV patients.  AIDS Centers usually have a dedicated team and are required to provide or arrange for inpatient care; coordinated outpatient services including a broad array of subspecialty services; long-term care, as necessary; and counseling and testing services.  AIDS Centers must make arrangements for patients' personal or home care as required and arrange for patients to participate in clinical trials.  AIDS Centers must enhance coordination with their community-based partners to identify patients at risk, help patients access and remain in care, and understand and adhere to their regimens.

The quality of care is monitored and evaluated by the HIV Quality of Care Program described in a separate section of this document.  Each AIDS Center is required to have an active quality program including a broadly inclusive quality improvement committee as well as a consumer advisory group and other mechanisms to involve consumers in improving services for PLWHA.

Currently, there are 45 AIDS Centers statewide treating approximately 36,000 persons with HIV/AIDS as outpatients and inpatients.

Contact:

Harrison Moss, MPH, MCHES
Coordinator, Acute & Chronic HIV Care Programs
Office of Medicaid Policy and Health Care Financing
518-486-1383
Harrison.Moss@health.ny.gov

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HIV Special Needs Plans (SNPs)/Managed Care

HIV Special Needs Plans (SNPs) are a comprehensive Medicaid Managed Care Plan option for individuals residing in New York City, Nassau and Westchester counties designed to meet the health care needs of people living with HIV/AIDS and other identified populations at high risk for HIV.  The SNPs also serve Medicaid-eligible persons that are homeless, transgender and dependent children up to age 21, regardless of their HIV status.  In addition to the full Medicaid benefit package, SNPs cover enhanced HIV services, care coordination, and behavioral health home and community-based services for eligible enrollees. 

HIV SNP networks include the full continuum of HIV services currently available in New York State.  Inclusion of health and human service providers with experience in the provision of HIV services enables SNPs to meet the complex medical and psychosocial needs of enrollees, either through direct service provision or by referral.  SNP experience with HIV populations has helped them expand networks to support the new population of negative homeless and transgender members.  SNPs have well developed care and benefit coordination procedures and relationships with health homes to support needs of members with complex medical, behavioral and psychosocial needs. Plan members with significant behavioral health needs may be eligible for additional home and community-based services to meet those needs. Clinical care provided by SNPs is in accordance with AIDS Institute established standards for HIV care and assessed through continuous quality improvement techniques.

The AIDS Institute assures quality HIV care is provided by Managed Care Organizations (MCOs), including the HIV SNP plans, through the development of programmatic standards for MCOs and quality of care reviews, and the AIDS Institute participates in Article 44 surveys. Technical assistance is also provided to MCOs regarding HIV prevention activities and establishing coordinated systems of care that are appropriate to the specific health care needs of enrollees with HIV/AIDS.

In 2015, the AIDS Institute initiated a pilot project in coordination with five MCOs to enhance outreach and engagement activities for virally unsuppressed members. Plans were given member level data that identified virally unsuppressed members, and members who have no documented viral load test results. The pilot MCOs were awarded contracts to build models of care that would provide outreach and engagement services to these members, with the goal of addressing barriers to care and reaching viral load suppression.  During the pilot phase, 41% of the unsuppressed members reached viral load suppression.  The success of the program facilitated the expansion of the project to all MCOs in New York State.  In July 2018, the AIDS Institute offered contracts to all MCOs in New York State to utilize best practices learned from the pilot project.

Contact:

Emily DeLorenzo
Section Director, Medicaid Managed Care / HIV SNP
Office of Medicaid Policy and Health Care Financing
518-486-13832
aims@health.ny.gov

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HIV Enhanced Fees for Physicians Program

The Enhanced Fees for Physicians Program (EFP) was established in 1991 by the New York State Department of Health to give private practice physicians enhanced Medicaid rates for HIV primary care visits. These visits include:

  • HIV testing
  • HIV post-test positive counseling
  • HIV monitoring

Physicians who participate in the HIV Enhanced Fees for Physicians Program must:

  • be in private practice and enrolled in the New York State Medicaid Program;
  • have active hospital admitting privileges;
  • be Board certified (preferably in infectious disease, internal medicine, family practice, pediatrics or obstetrics/gynecology);
  • provide 24-hour coverage; and
  • manage patient medical services, including hospital admissions and referrals for specialty care and social services.

Contact:

Janine Lloyd
Medicaid Policy and Programs
518-483-1383
Janine.Llyod@health.ny.gov

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HIV Primary Care Medicaid Program

The HIV Primary Care Medicaid Program (HPCMP) was established in 1989 by the New York State Department of Health to provide enhanced Medicaid rates to Article 28 facilities for HIV primary care and HIV testing visits.

Medicaid reimbursement methodology changes in 2008 ultimately required 85% of the HPCMP providers to adopt new procedure-specific Ambulatory Patient Groups (APGs). Since the full implementation of APGs, only Federally Qualified Health Centers (FQHC) that have NOT opted into the new APG methodology have continued access to the HPCMP rate structure.  FQHCs who meet enrollment criteria can access enhanced reimbursement for HIV testing and HIV treatment.

Enrollment criteria includes:

  • The facility must be a FQHC (Article 28 facility hospital OR diagnostic and treatment center); and
  • The facility must sign an agreement with the New York State Department of Health to provide comprehensive services and coordination of care for persons with HIV.

Contact:

Harrison Moss, MPH, MCHES
Coordinator, Acute and Chronic HIV Care
Office of Medicaid Policy and Health Care Financing 
518-486-1383
Harrison.Moss@health.ny.gov

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Family-Focused HIV Health Care for Women

Women affected by HIV experience inequities in social determinants of health (SDOH), poverty, substance use, domestic violence, mental illness, family disruption, and are often survivors of trauma. The medical care of women with HIV is further complicated by cultural/gender inequality and family issues that are distinct from those seen in their male counterparts. Women often have the primary responsibility for care of their children. Concerns regarding family and children often take precedence over their own health issues. In addition, women with HIV often face compounding issues such as custody arrangements, daily child care, disclosure, elder care, stigma and discrimination.

Family-Focused HIV Health Care is a comprehensive model designed to meet the needs of women living with HIV who are pregnant or have dependent children.  Engagement and retention in the health care system requires holistic, family-focused services that recognize the role of women as primary caregivers and address the multiple needs of their children.  The initiative seeks improved health outcomes through support and adherence to treatment regimens, access to culturally competent care, and reduced risk of perinatal HIV transmission.

The Family-Focused HIV Health Care model integrates HIV primary care, women’s health services, and pediatric care for infants exposed to HIV. Multicultural, multidisciplinary teams combine HIV specialty care, mental health counseling, prevention, medical case management, and other HIV-related support services to address the complex medical, mental, and health care needs of women and HIV-affected families. The model ensures ongoing communication among team members and community partners that promotes coordination of services and resources and seeks to address HIV-related stigma in health care settings and the community.  All efforts contribute to the goal of timely interventions and include aggressive engagement and re-engagement, support for addressing family issues, optimal early treatment and continuous care. These services are important for supporting pregnant women living with HIV to reduce the risk of perinatal transmission. In addition, they provide the opportunity to support women post-delivery, as postpartum women are at high risk for postpartum depression and more likely to delay returning to HIV care after delivery.

Contact:

Diane Grace
Initiative Director
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
diane.grace@health.ny.gov

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Adolescent/Young Adult HIV Specialized Care Centers

New York State has a significant number of adolescents/young adults, ages 13-24, newly diagnosed with HIV, especially among young men who have sex with men (MSM).  In addition, there are a number of perinatally HIV-infected adolescents/young adults.   

While the majority of adolescents perinatally infected with HIV have aged into young adulthood and transitioned to adult care, those still in adolescent/young adult programs tend to have significant risk reduction, developmental, mental health and self-management needs. With a lifetime of medical monitoring and ARV treatment regimens, potentially life-threatening illness, and stigma still surrounding HIV, they are also confronted with the physical, cognitive, psychosocial and emotional challenges of adolescence.

Adolescents and young adults may engage in risk behavior that leads to HIV and/or STIs.  Education about sexually transmitted diseases, risk reduction services and PrEP/PEP education and screening are critical to this population during this vulnerable phase of development. Adolescent and young adult friendly interventions are necessary to engage and maintain them in primary care, promote optimal health outcomes, and provide support for transition to adult service systems.

Specialized Care Centers provide comprehensive and coordinated HIV and primary health care, medical case management, and supportive services using a multidisciplinary team model.   Serving adolescents and young adults living with HIV and high-risk youth, SCC programs utilize an approach that enhances the health and well-being of youth in a health literate model. Programs are accessible to adolescents and young adults who engage in high-risk behaviors for HIV and other STIs, or who may have been exposed to HIV, and have clinic hours suitable for adolescents and young adults, particularly evening and/or weekend hours.

While the primary intent of the SCC is to serve youth with HIV, programs also reach and ensure clinical and supportive services to high-risk adolescents and young adults who are MSM, transgender, or other young people at high risk (e.g., runaway/homeless; involved in “street economy”/sex trafficking and substance use; victims of physical, emotional, and/or sexual abuse; gang-involved or involved with the criminal justice system). 

High-risk youth receive psychosocial, medical and social services assessments and are connected to  services such as: HIV counseling/testing and risk reduction services; care for acute illness and access to pharmaceuticals for uninsured youth; pregnancy testing, family planning and reproductive health care; STI screening, including extragenital testing as appropriate and treatment (including Expedited Partner Treatment);  screening/education, clinical assessment and prescription for PrEP/PEP; and referral for treatment of tuberculosis and hepatitis A, B, and C. Those identified as HIV positive are immediately linked to HIV care. High-risk youth who are not HIV positive, or who choose not to test for HIV, are referred for ongoing primary care and navigated to other needed services.   

Contact:

Megan Tesoriero
Initiative Director
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
megan.tesoriero@health.ny.gov

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Youth Access Programs

Adolescents/Young Adults frequently avoid health care settings that are not familiar or youth friendly. The stigma of HIV, possibly combined with mental illness, substance use, poverty, violence, trauma, and adverse social determinants of health, may present further barriers to seeking health care.

Adolescents and young adults may engage in risky activities, such as drug and alcohol use, which can often lead to sexual risk-taking. Contributing factors related to high risk-taking behaviors may include multiple life stressors such as exposure to violence, trauma, substance use, mental health issues, or engaging in sex for money, drugs or life sustaining needs.
The frequency and intensity of risk-taking behavior contributes to an increased potential for HIV, STIs and unintended pregnancy.

The Youth Access Program (YAP) reaches adolescents or young adults living with HIV who are not in care and connects them to HIV care via navigation activities or case management.  The program also serves young men who have sex with men (YMSM), transgender, and other high-risk youth whose HIV status is unknown and links them to primary health care, psychosocial and supportive services (e.g., child abuse/domestic violence, mental health, substance use treatment, etc.).  Follow-up is provided on critical referrals (e.g., PrEP, PEP, etc.) with navigation provided as needed. 

Youth Access Programs provide low threshold clinical services to high-risk youth (ages 13-24 years) in targeted and accessible community-based settings to meet their immediate health care and social service needs using a health literate program model.  Low threshold clinical services include: HIV counseling and testing and risk reduction services; Partner Services, STI testing including extragenital testing as appropriate and treatment (including Expedited Partner Treatment); PrEP/PEP education and screening, with clinical assessment and prescription directly or through immediate connection to care; pregnancy testing, family planning/ contraceptive counseling; psychosocial services; screening and referral for tuberculosis and hepatitis A, B, and C; and provision of or referral for immunizations. Medications for STIs or other infections and contraceptives for those without insurance are provided. 

Youth Access Programs are available at times suitable for young people’s schedules, particularly evenings and/or weekend hours, and at convenient community locations.  Methods to implement low threshold clinical services in community settings include medically equipped vans; part-time clinics in high-risk community-based settings where youth congregate; and mobile multidisciplinary teams.

Contact:

Megan Tesoriero
Initiative Director
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
megan.tesoriero@health.ny.gov

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Transgender Health Care Services

The Governor’s Ending the Epidemic Task Force identified transgender men and women among the populations that are disproportionately impacted by HIV. Transgender and gender non-conforming (TGNC) individuals are more likely to experience inequities in social determinants of health (SDOH), including low incomes, inadequate educational attainment, unemployment, and food and housing insecurity, resulting in poor health outcomes. TGNC individuals are more likely to have difficulties self-managing health conditions, such as HIV, to achieve viral load suppression, or navigating preventive services to achieve good health outcomes.

Transgender Health Care Services (THCS) are designed to decrease disparities in health outcomes and remove barriers within TGNC communities of color. Programs provide HIV/HCV/STI testing, early access to quality HIV and gender affirming health care consistent with established standards and guidelines, health care services including hormone therapy, mental health, medical case management and other supportive services in a transgender-friendly/competent setting. Programs facilitate rapid access (within 3 days) to HIV care and treatment for TGNC individuals living with HIV and improve access to ongoing transgender-friendly primary care services including PEP and PrEP education and initiation of regimens for high-risk TGNC individuals.

Multicultural, multidisciplinary teams combine HIV specialty care, mental health counseling, prevention, medical case management, risk reduction and other HIV-related support services to address complex medical, mental health and social issues. The model ensures ongoing communication among team members and community partners that promotes coordination of services and resources and seeks to address HIV-related stigma in community and health care settings. Programs provide outreach and utilize peers, social networks and social media to engage individuals who are not connected to ongoing care. Providers conduct workshops to promote education on HIV/HCV/STIs, managing health care and treatment regimens, navigating health care systems, and addressing inequities in social determinants of health.

Contact:

Diane Grace
Initiative Director
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
diane.grace@health.ny.gov

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Bureau of Hepatitis Health Care and Epidemiology

The Bureau of Hepatitis Health Care and Epidemiology (BHHC/E) is responsible for the development, implementation, maintenance and evaluation of a statewide comprehensive hepatitis C (HCV) programs and policies and hepatitis B and C surveillance activities. BHHC/E is also responsible for the implementation and tracking of the NYS HCV Elimination Plan. To coordinate activities focused on awareness, prevention, care and treatment of viral hepatitis, BHHC/E works closely with the New York City Department of Health and Mental Hygiene’s Viral Hepatitis Program and with other state health departments, federal partners and national organizations.

The Bureau of Hepatitis Health Care (BHHCE) is responsible for the following activities:

Implementation and Tracking of the NYS Hepatitis C Elimination Plan. BHHCE is charged with the implementation of the NYS HCV Elimination Plan and tracking NYS’ progress towards meetings its elimination targets.  This includes planning and hosting the NYS HCV Elimination Task Force and Workgroups, developing and supporting the elimination plan, establishing the primary and secondary metrics, performing the annual data analysis to monitor and report NYS’ progress towards meetings its elimination targets. 

Hepatitis C Care and Treatment Programs. BHHCE currently funds health care programs statewide to expand the capacity for HCV care and treatment within primary care settings, as well as non-traditional health care settings such as mobile units and harm education settings.  Funded programs provide outreach and recruitment, testing, HCV medical care, care coordination, treatment and supportive services. 

Hepatitis C Testing Program. BHHCE manages the NYS HCV Testing Program.  The screening program provides free rapid HCV antibody test kits and controls to programs serving populations placed at risk.  The program works collaboratively with the NYSDOH Wadsworth Center Laboratory to allow agencies enrolled in the screening program to conduct HCV RNA testing via dried blood spot.  Individuals screened for HCV are provided appropriate counseling messages and receive referrals for HCV RNA testing (if needed) and HCV medical care and treatment. 

Hepatitis C Patient Navigation Program. BHHCE supports HCV patient navigation services to people who inject drugs. This program aims to increase patients’ awareness of their higher potential risks for HCV and links those who are living with HCV to medical care and treatment.

Hepatitis C Program Evaluation. BHHCE is responsible for the evaluation of NYS HCV programs and policies. 

Hepatitis B and C Surveillance and Epidemiology BHHC/E is responsible for surveillance and epidemiology of HBV and HCV across NYS outside of NYC. The surveillance unit monitors the spread of disease, characterizes the population infected with HBV and HCV – including the coinfected population HCV-HIV and/or HCV-STIs-, conducts data quality activities for case ascertainment for HBV and HCV surveillance case reporting to CDC, collaborates in the development and enhancement of surveillance data systems, and provides technical assistance to local health departments.

Viral Hepatitis Strategic Plan. BHHCE is responsible for the maintenance of the NYS Viral Hepatitis Strategic Plan.  The mission of the strategic Plan is to outline a coordinated, comprehensive and systematic approach that will decrease the incidence and reduce the morbidity and mortality of viral hepatitis.  The vision is a state where viral hepatitis has been eliminated; where all New Yorkers have access to effective prevention services, know their viral hepatitis status, have access to high quality health care and treatment, free from stigma and discrimination.

Contact:

Colleen Flanigan, RN, MS
Director, Bureau of Hepatitis Health Care and Epidemiology
Division of HIV and Hepatitis Health Care
518-486-6806
colleen.flanigan@health.ny.gov

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Health Home Care Management

As part of New York State’s Medicaid Redesign and the Affordable Care Act, Health Homes were initiated across New York beginning in 2012 to provide comprehensive care management for Medicaid recipients with complex chronic illnesses.

Each enrolled Health Home member is assigned a dedicated care manager to assess their needs and help navigate, coordinate, and integrate the individual’s behavioral health, medical health, and social services. The goals of the Health Home program are to improve the health of enrolled members, improve the delivery of health care services, and reduce health care costs (by reducing unnecessary emergency room use and hospitalizations).

Health Homes are networks of providers administered by a lead agency. Networks include hospital systems, ambulatory care services (physical and behavioral), managed care plans, and community-based organizations providing medical services, behavioral health, housing, nutrition, legal, and other social services. In 2012, the AIDS Institute’s 45 former HIV Targeted Case Management (COBRA) providers transitioned to become Health Home care management providers.  A key component of Health Home care management is outreach, care coordination, and engagement activities. Designed to find and engage high-need, high-cost utilizers of unnecessary emergency care and Medicaid services, Health Home care management providers utilize a variety of outreach and care coordination methods, including peers, to engage eligible Medicaid recipients.

Contact:

Ese Oghenejobo, DrPH, Section Director
Health Homes/Acute and Chronic Care Services
Office of Medicaid Policy and Health Care Financing
518-486-1383
Ese.Oghenejobo@health.ny.gov

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Pre-Exposure Prophylaxis (PrEP) Services in General and HIV Primary Care Settings

Pre-exposure Prophylaxis (PrEP) is a biomedical intervention to prevent HIV among individuals at highest risk of acquiring HIV.  PrEP is a six-prong intervention for people who are HIV negative that includes: 1) taking one pill once a day; 2) periodic HIV testing; 3) counseling about the use of condoms to prevent STIs; 4) education about harm reduction options; 5) STI screening; and 6) counseling to promote adherence to the once-a-day PrEP medication.

In 2015, the AIDS Institute facilitated the establishment of PrEP services in general and HIV primary care settings.  This initiative uses a statewide prevention strategy that aligns with the Ending the Epidemic Blueprint goal of reducing the number of new HIV infections.

Grant-funded services are provided within general primary care settings that reach and engage individuals within communities most vulnerable to HIV.  These populations include, but are not limited to: men who have sex with men; transgender persons; injection drug users (IDUs); HIV-negative partners in a sero-discordant sexual relationship; persons that have had multiple courses of non-occupational post-exposure prophylaxis (nPEP); and heterosexual women in areas of elevated seroprevalence. 

PrEP services programs offer a comprehensive scope of services to ensure robust engagement for individuals most vulnerable to HIV. Programs are designed to increase PrEP awareness, facilitate access to PrEP and non-occupational post-exposure prophylaxis (nPEP), expand the number of PrEP prescribers, and provide patient navigation to reduce barriers to accessing PrEP services and care.  

Successful widespread implementation of PrEP requires collaboration between clinical providers, HIV testing programs, prevention programs, and support services providers. Funded agencies are charged with establishing and maintaining a community network tasked with developing a PrEP care continuum that is responsive to community need, solidifies area capacity, and effectively and efficiently leads potential clients to engagement in PrEP services.

Contact:

Claudia Vega
Assistant Director
Bureau of HIV Ambulatory Care Services
Division of HIV and Hepatitis Health Care
Claudia.vega@health.ny.gov