Summary

The AIDS Health Insurance Program (AHIP) assist individuals with AIDS or HIV-related disease maintain their health insurance coverage after loss or reduction of employment.

In New York City, AHIP is administered by the Human Resources Administration (HRA) through its Medicaid program. On the state level it is administered by the NYS Department of Health.

Description of AHIP

AHIP pays for an eligible individual’s health insurance premiums; it does not cover out-of-pocket expenses such as co-payments or deductibles.

AHIP will pay premiums for commercial health insurance for applicants who have existing coverage that was purchased directly from an insurance company or agent, coverage through their employer where the employee contribution for the coverage creates a financial hardship, or COBRA coverage when a person loses their job and cannot afford the premiums.

AHIP beneficiaries have their health insurance premiums paid directly to the insurance company.

Qualifying for AHIP

CATEGORICAL FACTOR

Applicants must have AIDS or an HIV-related disease, which must be documented by a physician. An AIDS diagnosis must meet the criteria set forth by the Centers for Disease Control and Prevention (CDC). An HIV-related disease must be one that is included in the standard for Clinical/Symptomatic HIV disease, as determined by the AIDS Institute of the New York State Department of Health.

CITIZENSHIP/IMMIGRATION STATUS

AHIP is NOT available to undocumented individuals.

AHIP applicants must meet the citizenship/immigrant requirements of the Medicaid program, which includes American-born and naturalized U.S. citizens, all qualified aliens (refer to Immigrants Rights and Services, Immigrants’ Eligibility for Public Benefits, Immigration Statuses, Qualified Aliens), as well as those individuals permanently residing under color of law (PRUCOL), meaning immigrants residing in the U.S. with the knowledge and permission of the United States Citizenship and Immigration Services (USCIS) and whose departure from the U.S. the USCIS does not contemplate enforcing.

RESIDENCY

Applicants must prove they are residents of New York State. There is no durational requirement for residency in NYS. Applicants must apply in county of residency. In NYC, an applicant can apply in any of the five boroughs.

ACCESS TO HEALTH INSURANCE

Applicants must have some form of health insurance in place at the time they apply for AHIP. They must:

• Be eligible to continue participation in the group health insurance plan provided by their employer or to convert their employer’s group coverage to individual coverage; or

• Be, or have been, self-employed and eligible to continue their health insurance coverage under the plan they maintain.

ASSETS/RESOURCES

Resources are not considered when determining eligibility, however dividends and interest on accounts, such as checking and savings, are considered income and will be considered when determining eligibility.

INCOME

The household’s gross income must be less than 185% of the federal poverty level. No income deductions are available.

Applying for AHIP

APPLICATION

Applicants should complete the Medicaid application Access NY Health Care, the DOH-4220. The applicant should write AHIP on top of the application. Go to https://www.health.ny.gov/forms/doh-4220.pdf or call the HRA Info Line at 718-557-1399. An authorized representative may act on the applicant’s behalf.

APPLICATION PROCESS

Applicants must have insurance in place at time of application. Therefore, if the insurance coverage is scheduled to end, individuals must apply before the scheduled end date. If an individual loses health insurance before they apply for AHIP, AHIP cannot replace the insurance or purchase new insurance.

Applicants should call the Medicaid Client Representative Unit at 929-221-1970 to schedule an appointment to submit their application. All appointments will be held at the Central Medicaid office located at 785 Atlantic Avenue, in Brooklyn. Upon making an appointment, applicants will be informed where within the building their meeting is to be held.

Applicants are required to submit picture ID, proof of citizenship, proof of residency, proof of income, and documentation from a doctor regarding HIV/AIDS status. If certain documentation (such as proof of income or citizenship) is not available at the time one applies for AHIP, the application will be held in deferral for a brief period of time (approximately 10-14 days) until the documentation is provided. If the documentation is not provided within the required timeframe, the application will not be processed.

For assistance applying for AHIP, Community Health Advocates can assist NYC residents – 888-614-5400.

PROCESSING AND NOTICE

There is a 45-day processing period, from the time an application is submitted.

A Notice of acceptance or denial, will be mailed to the applicant. Individuals who are denied benefits may appeal the decision through a fair hearing.

WHEN BENEFITS BEGIN

Benefits begin upon determination of eligibility, which can take up to 45 days. Applicants must continue to pay insurance premiums until they are enrolled in the program. However, applicants who are approved for AHIP can receive reimbursement of premiums for up to three months prior to submitting the application.

Recertifying for AHIP

RECERTIFICATION PROCESS

In most circumstances, AHIP can be authorized for up to 12 months. At the end of the certification period, Medicaid will recertify the recipient’s continued eligibility for coverage. AHIP recipients will renew their Medicaid through a mail-in recertification/renewal process.

About 3 months prior to the end of a recipient’s certification period, Medicaid will mail a renewal package to the AHIP recipient. These recipients will be able to recertify or renew their Medicaid either through a mail-in recertification/renewal process. An in-person interview is not required.

Recipients who have not received a renewal package in the mail or who have lost his/her original may request a replacement package. If the renewal due date is greater than two weeks in the future, the individual can call the HRA Medicaid Helpline at 1-888-692-6116. If the renewal due date is less than two weeks in the future, the individual should go to the Medicaid Renewal Center at 785 Atlantic Avenue, in Brooklyn to request a renewal package.

Recipients must complete and sign the Medicaid Mail Renewal Notification, as well as the Terms, Rights and Responsibilities form, and return both in the postage-paid envelope by the specified date on the renewal form. The renewal form will be pre-printed with the household’s current information, such as household size, residency, income, etc. Households must indicate any changes on this form. If the recipient fails to return the renewal package, MAP will send a reminder notice in the mail.

RULES FOR REPORTING CHANGES IN BETWEEN CERTIFICATION PERIODS

AHIP participants are required to report changes at the time they occur, even if it is between certification periods. Documentation of any relevant changes should be submitted to the local Medicaid office.

FAILURE TO RECERTIFY

Failure to recertify will result in termination of AHIP benefits