For New Patients: An Overview
Whether you are newly diagnosed or transferring care from another clinic, we want you to feel welcome and well-supported with Southwest Care Center. We want you to know that you can live a long, healthy life with HIV and that you are not alone.
We have included below an overview of the process of starting care with us, including links to get to know our Santa Fe providers, our Albuquerque providers, the clinical services we provide, additional support services available and paying for care.
Confidentiality
Protecting the confidentiality of your medical information is important to us. We maintain strict patient confidentiality regarding your diagnosis, care, and treatment. This includes the way in which we communicate with you via phone and mail.
We also take steps to ensure that simply coming to your appointments does not reveal your HIV status. Our clinic serves individuals with other medical conditions and needs.
Newly Diagnosed
If you have recently been diagnosed with HIV, we will schedule you for an appointment at our clinic within one week or less of receiving the diagnosis. You should bring any medical records that you have or contact information about how we can acquire your medical records.
Transfer of Care
For patients who have already been in treatment for HIV, but are new to Southwest Care Center, the first appointment is generally scheduled within one month of contacting us to request one.
Your First Appointment
Your first appointment will be approximately 60 to 90 minutes. You should check in with the reception desk when you arrive at the clinic. You will meet with a medical case manager, a nurse and provider — they will comprise your care team.
Your Medical Case Manager is an important member of your care team. At your first visit, you will get an overview of the services and support they can provide. One concern for many patients is the financial cost of treating HIV. Your medical case manager will help you understand and navigate the programs that help to reduce the costs of paying for care. Southwest Care Center also offers a wide range of additional support services through the Ryan White Program, such as transportation assistance.
Clinic nursing staff are also a part of your visit. The nurse will review what to expect and what is needed for future appointments. They will be available to answer any questions you have about the first and any follow-up visits. If any injections or immunizations are needed, the nurse will provide them. The nursing staff is also available to provide educational and emotional support.
As part of your appointment, you will go to the lab, where blood will be drawn for several laboratory tests. The results of these lab tests will help you and your provider develop the best plan to manage your HIV care so that you can get the virus under control and protect your health.
Your first follow-up visit will be two weeks after your initial appointment to discuss the lab results. Follow-ups after that usually range from 3 to 6 months, based on your care team’s recommendations.
Finally, you will meet with your provider to discuss your diagnosis, clinical services we provide, and treatment options. They can also address any concerns you have with informing sexual partners of your status and preventive measures your partners can take.
Paying for Care
Need Help?
If you do not have insurance or having trouble with out-of-pocket costs related to your care, please contact your medical case manager.
Most people living with HIV struggle with the cost of medical care and medications. The difficulty in completing paper and online applications to obtain public benefits and/or private insurance may discourage some patients from accessing ongoing healthcare.
Southwest Care Center has funding to assist uninsured and underinsured patients to access care. Our Medical Case Managers (MCMs) are trained to help you enroll in benefit programs while you are at the clinic.
Medical Case Managers will check your eligibility for employer-sponsored insurance, Affordable Care Act marketplace insurance plans and subsidies, Medicaid, Medicare and VA benefits. Medical Case Managers will also look at your income to determine if you qualify for Ryan White-funded services and/or the AIDS Drug Assistance Program (ADAP).
If you are eligible for Medical Case Management, your assigned Medical Case Manager will meet with you at least three times each year to discuss assistance that you may need to ensure that you are attending medical appointments regularly and to complete on-going Ryan White and ADAP re-certifications.
In addition to helping patients get health insurance, Medical Case Managers may also help you apply for copay assistance programs, food support, energy assistance, Department of Workforce Development programs/benefits, and provide referrals for housing and rental assistance.
Most insurance plans provide coverage for HIV-related care; however, out-of-pocket deductibles and coinsurance costs can be challenging. Your assigned Medical Case Manager can provide assistance to help you find programs that will help with these costs. Even if you are able to afford medication copays, you may be eligible to reduce your out-of-pocket medication expenses through manufacturer copay card programs. Our Medical Case Managers are available to help you get connected to this important resource.
Ryan White Coverage and Eligibility
Am I eligible for the Ryan White Program?
You are eligible for Ryan White coverage if you:
- Are HIV positive
- Have a household income under 400% of the Federal Poverty Level (pdf).
- Are a New Mexico resident
How do I get coverage?
- A Medical Case Manager will enroll you in the Ryan White Program if you are eligible.
- If you ever lose your health insurance, please contact your Medical Case Manager or ask for the intake Case Manager immediately for assistance in obtaining other coverage. This is very important so you can continue to see your doctor and get your medications.
What does Ryan White cover?
The Ryan White Program covers the costs of medical care and support services for both uninsured and insured eligible individuals. If you are uninsured, the Ryan White Program will cover the primary charge for the service and you may be responsible for a small copay. If you are insured, the Ryan White Program will provide assistance with your copays, coinsurance and deductibles for eligible services.
Will I pay anything if I’m enrolled in Ryan White?
- You may be responsible for a copay based on your individual income.
- Please call us to update your income if it changes, so your copay amount is correct
Coverage
Medical Services Within HIV Clinic Ordered by HIV Provider:
- HIV clinic visits with HIV medical provider
- Labs: CD4 count and viral load, resistance testing; Other diagnostic labs, tests, procedures or imaging ordered by HIV medical provider (including ultrasounds, CT scans, MRIs, lung function tests, bone mineral density scans).
- Cervical cancer screening: annual cervical pap smear in HIV clinic and referrals to Gynecology for follow-up for abnormal cervical paps, including repeat cervical paps, colposcopies, and biopsies (cervical cancer treatment not covered)
- Anal cancer screening (anal cancer treatment not covered):
- Annual anal pap done in HIV clinic
- Referrals to colorectal surgery clinic for anoscopy/biopsy needed for follow-up of abnormal pap
- Referrals to surgeon for consultation on Condyloma
- Screening and treatment for tuberculosis (TB)
- Screening and treatment for Hepatitis B and C
- Screening and treatment for sexually transmitted infections (STIs)
- Routine immunizations administered in HIV Clinic
- Primary care provided in HIV Clinic
- Urgent care provided in HIV Clinic
- Smoking cessation treatment
Other Services Within the HIV Clinic:
- Clinical pharmacy consultation provided in ID clinic
- Mental health screening and referral for treatment
- Addiction screening and referral for treatment
- Syringe Exchange Services
- Overdose Prevention/Naloxone
- Condoms – external (aka, male) and internal (aka, female or insertable) – and lubricant
Medications:
- Antiretrovirals and other HIV related outpatient medications (primarily covered by ADAP program)
- Other outpatient medications, not covered by ADAP:
- Other outpatient medications prescribed by HIV provider, primary care provider, or psychiatric/addiction medicine provider filled at UW Health Pharmacy.
Additional Support Services
Covering the Costs of Health Care
Your assigned Medical Case Manager will help you to understand your health care coverage options and assist you with enrollment. They have extensive experience working with Medicaid, Medicare, the Affordable Care Act (ACA), Employer Insurance Plans and other programs to help cover the cost of medications and medical care. They will also assess your eligibility to receive Ryan White Program assistance for additional help with out-of-pocket costs related to HIV care including insurance premium assistance. The HIV program at Southwest CARE Center is partially funded through a grant from the Ryan White Care Act. As a recipient of Ryan White funds, Southwest CARE Center will not charge you for services if your health care costs exceed an annual payment cap. This cap is a percentage of your annual income and follows the guidelines described in the Ryan White Care Act. The payment cap limits the amount you can be charged by us for out-of-pocket medical expenses. For more details, see the attached Ryan White Payment Cap 2020.
Transportation Assistance
Some people may have trouble getting to their appointments. A goal of our program is to help patients to improve access to transportation to attend medical appointment. Your assigned Medical Case Manager will assist you with identifying and using existing transportation resources. When other modes of transportation are not available, our program may be able to provide mileage reimbursement to eligible individuals to ensure they can make it to their medical appointments.
Medical Case Management
Your assigned Medical Case Management will help you with care coordination so that you are able to attend appointments, take medications as prescribed and are referred to other programs and services in the community that will help you with most basic living and housing needs.
Linkage to Care Program
Southwest Care Center is committed to helping people access HIV care as soon as possible. We offer a Linkage to Care Program where we aim to quickly engage people who are either newly-diagnosed, or who are aware of their HIV diagnosis and not currently being seen by a provider. Medical Case Managers serve as a patient navigator, helping people connect to HIV medical care and develop the knowledge and skills necessary to be active participants in their health care.
Behavioral Health Services
Southwest Care Center recognizes that living with chronic illness may be stressful at times. Once a year, our Medical Case Managers will offer conduct an assessment and develop an individual service plan that can help identify any impact stress may be having on your daily life. If you are interested, they can also help link you to behavioral health providers. Additionally, our clinic has on-site Behavioral Health providers that are also available to you.
Housing Services
We recognize that worries about housing can impact how a person takes care of their health. To help address this, we can link clients to housing assistance, emergency financial assistance and federally funding housing programs including HOPWA (Housing Opportunities for People Living with AIDS) to provide housing navigation, case management, eviction prevention and financial assistance to eligible individuals.