There are four (4) required criteria when determining the eligibility of a person for Ryan White services. The provider must have documentation all required criteria in the client’s official record and client must be eligible for services before requesting payment for provided services, and include:
1) Documentation of HIV status (proof of HIV diagnosis/confirmatory lab test results), OR written letter from a Medical Provider of the HIV Disease:
- A positive HIV status needs to be established only once, during the initial intake.
- Acceptable documentation to establish HIV positive diagnosis would be a copy of any laboratory result confirming an HIV/AIDS diagnosis or a statement from a clinician confirming a history of HIV/AIDS diagnosis. (CD4/VL results not used as proof of HIV status)
2) Documentation of Permanent Alabama residency:
- Established at initial assessment and then at each Annual and Six Month assessment if any changes and on demand prior to providing any RW service.
- Acceptable documentation could include a PO BOX with supporting documentation of the applicant’s street address (i.e., utility bill; or other legal address documents) OR when no permanent physical address, (i.e., homeless; transient), provide a detailed Statement of Temporary Housing during the application process.
3) Documentation of Income:
- The income level for Alabama’s Ryan White Part B/ADAP Program eligibility set by the ADPH is equal to or less than 400% of the current year’s Federal Poverty Level (FPL). The FPL guidelines change annually and can be accessed at: https://aspe.hhs.gov/poverty-guidelines.
- Income eligibility is based on the total gross income of the client. Gross income is income before deductions of income, taxes, social security tax, etc.
- Detailed No Income explanation of daily living expense source(s) when claiming zero income required during application process.
- Income documentation must be included in the client’s clinic chart for review upon request by the Program Recipient or Sub-Recipient Agency Representative. The following types of documentation are acceptable forms of income verification and must be verified before services are provided:
- Copy of most current 1040 (include Schedule C; i.e. business owner)/1040EZ signed by client,
- Payroll stubs – two (2) consecutive current pay stubs are required at time of application and before RW services are provided (no exceptions) = stubs dated outside of the 90-days of date of intake are not valid,
- Client with no pay stubs – Statements from an employer verifying gross pay, letter older than 30-days prior to intake is not valid, (statement from employer may be verified)
4) Verification of Third Party Payers:
- Clients eligible to enroll or are enrolled in public or private insurance are not eligible to receive RW funded services in most cases. However, enrollment or eligibility to enroll in other payer sources does NOT automatically exclude a client from eligibility to receive Ryan White (RW) services during special instances with supporting documentation, (i.e., a waiting period; gaps in coverage; underinsured, missed open enrollment)
- Documentation of verification of third party payer enrollment or eligibility to enroll must be included in the client’s clinic chart for review upon request by the Grantee Recipient or Sub-Recipient Agency Representative. Confirmation of enrollment or eligibility to enroll in any public or private insurance should include the following sources:
- Medicare Part D
- Low Income Subsidy Assistance (“Extra Help” to enroll in Medicare Part D (MEDCAP)
- All other Public or Private Insurance – must have a copy of insurance card in client record
Reassessment of a client’s enrollment or eligibility to enroll in any third party payer sources is to be completed Annually and every Six Months for active enrollees. Ryan White HIV/AIDS Part B/ADAP/AIAP/MEDCAP electronic application process will include additional required upload attachments for application completion when applicable. Alabama’s Ryan White HIV/AIDS Part B Service clients not accessing ADAP services will need to complete a paper application and attached additional required documentation Annually and every Six Months for review at the RW recipient site until access to global sharing. Copies of public or private insurance enrollment cards along with a copy of the public or private insurance benefits booklet summary outlining insurance coverage must be available in the client’s clinic record for review upon request by the Program recipient and/or the State’s RWHAPB Lead Agency representative (No exceptions when applicable).
Guidelines revised March 2017. For more detailed information, see Part B Program Eligibility Standards.
State covers some form of HCV drug therapies as part of their approved drug formularies: Yes
To learn more about what HCV drug therapies are on the drug formulary, please visit tiicann.org/co-infection-watch.html (go to page #7).