There are four (4) required criteria to apply in determining the eligibility of a person for Ryan White services. The provider must document all criteria in the client’s official record before requesting payment for services rendered, and include:
- Documentation of HIV status (proof of HIV diagnosis), OR Medical Diagnosis of the HIV Disease: A positive 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.
- Documentation of Permanent Alabama residency; Established at initial assessment and then every 6 months or on demand prior to rendering any service. Acceptable documentation could include a PO BOX with supporting documentation of the applicant’s street address (i.e., utility bill; lease) OR when no permanent physical address, (i.e., homeless), complete a Temporary Residence form. (Access forms at www.adph.org/aids then click on Drug Assistance Program) Alabama’s Ryan White Part B Program Eligibility Standard Revised – 09-2013 3
- Documentation of Income: The income level for Alabama’s Ryan White Part B Program eligibility set by the ADPH is equal to or less than 300% of the current year’s Federal Poverty Level and the State’s ADAP enrollment requirement is equal to or less than 250% of the Federal Poverty Level. The federal poverty guidelines change annually and can be accessed at http://aspe.hhs.gov/poverty. Income eligibility is based on the total gross income of a household with whom the HIV+ client has a legally responsible relationship (for example, legal spouse or children (biological, adopted or step children). Gross income is income before deductions of income taxes, social security tax, etc. The income level for all working members of a household are factored when computing the income level (i.e., Legal Spouse and/or adult children (biological, adopted or step children) living in the house with the client. Income documentation must be included in the client’s clinic chart for review upon request by the Grantee or Lead Agency Representative. The following types of documentation are acceptable forms of income verification:
- Copy of most current W2,
- Payroll stubs (2 consecutive stubs) dated current = within 90-days of date of intake and/ or date of RWPB-ADAP Standard Application submission date,
- Notarized statement from an employer on official company letterhead showing gross pay for the 30-days prior to intake,
- Letter with current year’s date from the Department of Social Services that documents receipt of an entitlement.
- SSI/SSDI benefits letter or application or denial letter
- 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 or Lead 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
Reassessment of a client’s enrollment or eligibility to enroll in any third party payer sources is to be completed every 6 months using the Alabama’s Standard Ryan White/ADAP Reassessment Form. A copy of any applicable public or private insurance enrollment cards along with a copy of the private insurance benefits book outlining insurance coverage when applicable must be available in the client’s clinic record for review upon request by the Grantee and/or the State’s RWPB Lead Agency representative.