Eligibility

1. Eligibility HIV/AIDS Patient Care Programs

2. HIV/AIDS Patient Care Programs • The eligibility process is required for the following Patient Care Programs: • Ryan White Part B Program • AIDS Drug Assistance Program (ADAP) • AIDS Insurance Continuation Program (AICP) • State HOPWA (Housing Opportunities for Persons with AIDS) • County Health Departments HIV/AIDS Programs (DOH)

3. Eligibility Documentation • Clients must present the following documentation at intake in order to determine eligibility: • Completed Signed and Dated Application • Income Documentation • Proof of Insurance, if applicable • Proof of Living in Florida • Proof of HIV

4. Eligibility Determination • Client must also not be participating or eligible for another local, state, or federal program that offers the same services requested (i.e. Medicaid). • Patient Care Programs are Payor of Last Resort- all other programs must be exhausted before receiving services funded by Patient Care Programs. • Please Note: Minors may receive HIV/AIDS services without parental consent.

5. Eligibility Determination • For eligibility determination, the client meets with a Project Response Eligibility Specialist to determine eligibility. If the client has all required documentation and is eligible, a Notice of Eligibility is issued for 6 months. • If the client needs more documentation, the Eligibility Specialist has 30 days to complete the intake process, or must document the delay. • If the client is found ineligible, a Notice of Ineligibility is provided to the client. The client has the right to file an appeal with the State.

6. Eligibility Continued • Once a client is determined eligible, there are a few more steps in the process before the client is referred for other services. • Consent forms must be signed by the client authorizing release of information • Client must be provided the Notice of Privacy Practices • Client must agree to the Client Rights and Responsibilities • Eligibility Specialist must complete the Eligibility Staff Assessment Worksheet (this worksheet covers the required documentation and income)

7. Redetermination for Eligibility • In order to continue to receive Patient Care Program services, the client must meet with the Eligibility Specialist every 6 months, or sooner if circumstances have changed. • Clients will need to provide current information especially as it relates to changes in income. • Information already in the file that has not changed does not need to be collected again. • A new Notice of Eligibility/Ineligibility will be provided to client.

8. Referrals • The primary tasks by eligibility staff after a determination of eligibility include referrals. • Eligibility staff should explain case management services (case management is not mandatory). • If the client wants to receive case management, the client should be referred. • Review the allowable services in the area and make the appropriate referrals. • If the client is in need of insurance assistance, medications or housing needs, the client can be referred directly to these programs. The client must provide the Notice of Eligibility as verification.

9. For Additional Information on Eligibility/Redetermination • You may visit the following web address for the complete Florida HIV/AIDS Eligibility Procedure Manual http://www.doh.state.fl.us/disease_ctrl/aids/care/EligibilityAdRule.html • You may register for the online Eligibility Training with the Department of Health at http://www.doh.state.fl.us/disease_ctrl/aids/care/Core%20_Eligibility_Pre.html