Ryan White Program
Ryan White Part B Services Eligibility Policy
The State of Tennessee provides HIV drug assistance, medical services and insurance assistance for eligible Tennessee residents. To be eligible for coverage by the Ryan White Part B Medical Services Program, the Insurance Assistance Program, and the HIV Drug Assistance Program, a recipient must meet the following criteria and then see a Medical Case Manager:
- The recipient must have been diagnosed with HIV/AIDS.
- The recipient must be a resident of Tennessee.
- The recipient must meet the income guidelines established by the program: modified adjusted gross monthly income for the legal household unit is less than or equal to 400% of current Federal Poverty Level.
- All clients must be evaluated for eligibility by a Medical Case Manager when the initial application is submitted to the Ryan White Part B Program.
- All clients must be recertified semi-annually (per HRSA policy).
- A recertification application must be sent to the Tennessee Department of Health, Ryan White Part B Program via the Ryan White Eligibility System.
- Recertification should occur on, or close to six (6) months from the client’s original application date.
- Recertification may occur forty-five (45) days prior to the due date. The next recertification will be due in six (6) months.
- If a recertification form is not received by the due date, the client will be disenrolled, and the pharmacy will be notified that the client is no longer on the program.
Proof of HIV Requirements
One of the following is considered acceptable proof:
- A positive HIV sero-status confirmed by a Western Blot assay;
- Positive results with a Rapid/Rapid Test recorded on the PH1600 reporting form;
- Laboratory results showing a detectable viral load;
- A letter, office note or discharge summary signed by a licensed physician documenting HIV or AIDS as a diagnosis may be used temporarily until one of the first two described lab results can be obtained.
Identity and Residency Requirements
To be deemed eligible for coverage by state Ryan White Part B Services Programs, a recipient must have documentation to verify Tennessee as their home.
- Photo identification*
- Valid Driver’s License
- State Identification Card
- Valid Student Identification Card from State College/University
- Library card with photo (if available)
- Jail/prison identification, booking sheet, transportation Identification, photo taken by MCM staff and/or electronic medical record photo.
- If client’s photo Identification is out of state or expired, it can be used for the first eligibility determination process; but cannot be used to prove residency. A valid Tennessee – issued driver’s license or Identification card must be presented at the next six month recertification appointment.
*In lieu of photo Identification, two of the following (based on Tennessee Department of Safety documentation requirements) must be provided as proof of identification and/or residency:
- One document from the following list:
- Current mortgage or Rental Lease agreement in recipient’s name
- Current Tennessee utility bill (landline telephone, electric, water, gas, cable, etc. ) in recipient’s name and address. Wireless telephone bills will only be accepted if documents that residence does not have landline phone.
- Current employer verification of residence address or letter from employer as long as it is on company letterhead with original signature. If employer does not have letterhead, then signature of employer must be notarized.
- Letter from a verifiable homeless shelter or community center serving homeless individuals with clear identification and verification of residency
- Letter of Support
- Mail postmarked within the last 30 days and delivered to recipient’s street address.
- Printout or benefits statement, etc.
- Social Security Check or Direct Deposit Verification of SS Check
- Health Insurance Card
- TennCare, Medicaid, Medicare, etc.
- Health Insurance Card
- Insurance policies or payment statements
- IRS/state tax form
- W2 forms, property tax receipts, etc.
- Military Records
- Assignment orders, selective service cards, Leave & Earnings Statement, etc.
- United States or Foreign
- School Records
- Transcripts or grades
- Elementary immunization or “shot” records
- Diploma or GED
- Vehicle Documents
- Vehicle registration or title
- Bill of Sale or purchase contract
- Proof of any Name Changes if different than name on Primary ID
- A Social Security Number or sworn affidavit if no Social Security number has been issued.
If under 18 years of age, the above documents are needed plus:
- A Tennessee Affidavit/Financial Responsibility
Proof of Residency:
- Current bank statement (internet bank statements are acceptable only if taken to the local bank, stamped, and dated by teller as active account. Checks and checkbook information are not acceptable)
- A valid (non-expired) Tennessee driver’s license or Tennessee State issued ID, voter registration card, and/or food stamp document can be used for proof of residency. Address must match the address used on any documentation used for proof of income.
- Current paycheck/check stub, work ID or badge, if address is included.
- Current automobile, life, or health insurance policy (wallet cards cannot be accepted)
- Current driver’s license/ID issued by TN Dept. of Safety to a parent, legal guardian or spouse of applicant.
- Current TN motor vehicle registration or title
- Current TN voter registration
- Receipt for person property or real estate taxes paid within the last year
- In case of student enrolled in public or private school in this state, student may provide a photo student ID and acceptable documentation from the Dean or Bursar Office that the student lives on campus.
The Ryan White Part B Medical Services Program serves eligible Tennessee residents with HIV/AIDS. This program covers Part B clients that do not have any form of health insurance. A Medical Case Manager will assess each client’s eligibility for this program when they apply for Part B coverage. The program primarily covers procedures directly or indirectly associated with HIV/AIDS and related illnesses. A fee schedule of covered procedures and the amounts paid is updated each year and sent to all authorized providers. For a health care provider to be authorized by program, they must complete and submit a state “Authorization to Vendor Form” each year, and agree to accept the Fee Schedule amount as payment in full.
The program does not cover emergency room charges or inpatient costs. The payment of any uncovered services is the responsibility of the patient.
The Ryan White Part B Insurance Assistance Program (IAP) began in 2000. This program assists Ryan White-eligible HIV/AIDS clients in Tennessee with health insurance premiums, co-pays and deductibles, and should not be considered an entitlement. Benefits of the Ryan White Part B Insurance Assistance Program are subject to periodic adjustment based on available funds and program expenditures.
- Medical Case Managers assist clients with applying for the program, which is administered by a fiscal agent contracted by the state.
- Funds from the program may be used to pay for the "out of pocket" health insurance premium (for a policy already in effect) as well as deductibles and/or co-pays.
- Eligibility for IAP is the same criteria used by Medical Case Managers to qualify a patient for the Medical Services Program and HIV Drug Assistance Program (HDAP).
- If you think you might be eligible, please contact the Medical Case Manager for your area.
- If you are unsure whom you should call, you may contact the State Of Tennessee ADAP program for assistance at (615) 741-7500 or 1-800- 525-2437.
Tennessee HIV Drug Assistance Program (HDAP)
The Drug Assistance Program is funded through Ryan White Part B. The program is designed to assist with the purchase of specific drugs for eligible, low-income individuals with HIV who have no other source of health coverage.
HDAP Information for the Physician/Medical Case Manager
- Medical Case Managers must ensure that the application is completed, signed, and dated. The application is submitted through the Ryan White Eligibility System.
- A client recertification is required every six (6) months. An updated application must be submitted before the six (6) month recertification due date or the client will be terminated from the program.
- All applicants must have an attending physician who agrees to prescribe the drug(s) approved under this program and medically monitor the applicant in accordance with federal guidelines for use of the drug(s) in the treatment of HIV disease.
- Clients must inform their Medical Case Manager if they are transferring to another physician's care and follow-up, or if they are approved for TennCare or any other source of health insurance with prescription coverage (at that time HDAP benefits will cease, but they may qualify for the other Ryan White Part B services).
- Per the T.C.A. 68-10-101 and "Notifiable Disease Reporting Regulations of the Tennessee Department Of Health, health care providers diagnosing, treating, or prescribing for a person with HIV and/or AIDS must report this to the designated regional health department surveillance personnel. For information about how to report a case, call (615) 741-7500.