Transcript Eligibility Process

HIV/AIDS Patient Care Programs
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The eligibility process is required for the following
Patient Care Programs:
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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)
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Clients must present the following documentation at
intake in order to determine eligibility:
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Completed Signed and Dated Application
Income Documentation
Proof of Insurance, if applicable
Proof of Living in Florida
Proof of HIV
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Client must also not be participating or eligible for
another local, state, or federal program that offers the
same services requested (i.e. Medicaid).
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Patient Care Programs are Payor of Last Resort- all
other programs must be exhausted before receiving
services funded by Patient Care Programs.
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Please Note: Minors may receive HIV/AIDS services
without parental consent.
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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.
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If the client needs more documentation, the Eligibility Specialist has
30 days to complete the intake process, or must document the
delay.
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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.
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Once a client is determined eligible, there are a few
more steps in the process before the client is referred
for other services.
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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)
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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.
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Clients will need to provide current information especially
as it relates to changes in income.
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Information already in the file that has not changed does
not need to be collected again.
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A new Notice of Eligibility/Ineligibility will be provided to
client.
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The primary tasks by eligibility staff after a determination of
eligibility include referrals.
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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.
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Review the allowable services in the area and make the
appropriate referrals.
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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.
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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/Eligi
bilityAdRule.html
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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