Patient Care Eligibility

(a) Ryan White Part B Consortia Program.

(b) Ryan White Part B AIDS Drug Assistance Program.

(c) Ryan White Part B AIDS Insurance Continuation Program.

(d) State Housing Opportunities for Persons with AIDS Program, and

(e) HIV/AIDS Patient Care Programs provided by the patient care networks and county health departments as administered by the Department of Health, Bureau of HIV/AIDS.

-Updated 2009-2010 Federal Poverty Level (FPL). The FPL for use when determining eligibility has been updated in the Eligibility Rule Chapter 64D-4 F.A.C. The following 2009-2010 Annual and Monthly Income charts replace the 2008 versions currently referenced in the Eligibility Manual.
2009-2010 Federal Poverty Level (FPL)(pdf, 22kb)

(A) The Eligibility Requirements(.doc,29KB)

List of the eligibility requirements for all of the HIV/AIDS Patient Care Programs as required by Chapter 64D-4 Florida Administrative Code (F.A.C.).

For programmatic qualifications for enrollments, please select one of the following links.

Ryan White Part B AIDS Drug Assistance Program

Ryan White AIDS Insurance Continuation Program

State Housing Opportunities for Persons with AIDS Program

(B) Eligibility Brochure (pdf,1.46MB)

Official eligibility information brochure. This brochure was prepared especially for applicants and explains the eligibility requirements and procedures in question and answer format. This brochure which also includes the application can be found at any county health department.

(C) Eligibility Application(pdf,1.41MB)

Official application completed by an applicant or with help from eligibility staff. The application is a part of the brochure and can be found at any county health department.

(D) Eligibility Rule Text (pdf,29.7KB)

Entire rule text of Chapter 64D-4 Eligibility Requirements for HIV/AIDS Patient Care Programs.

(E) Eligibility Determining Procedure's Manual (pdf,95.2KB)

Determining Eligibility Staffs Procedure Manual. This document contains the procedures and requirements for determining eligibility in conjunction with Chapter 64D-4 F.A.C.

(F) Technical Assistance/Eligibility Questions/Answers (pdf,117KB)

Eligibility questions raised during the implementation of the eligibility rule and the responses. These responses should be used by eligibility staff and included with the Determining Eligibility Staff Procedures Manual

(G) Implementation Memo (pdf,893KB)

Implementation of the Eligibility Rule interoffice memorandum disseminated statewide after the adoption of Chapter 64D-4 F.A.C.

(H) Attachment Rule 64D-4 memo (pdf,893KB)

Attachments

Attachment to Eligibility Manual A through T
All files are .PDF format and under 5mb in size all files open in a new window

Attachment	Name	Page Number	Requirement
Attachment A	Eligibility Rule Text	A1	N/A
Attachment B	Ryan White Program Service Definitions	A2	N/A
Attachment C	DH 1120 Computer Use and Confidentiality Agreement	A3	A version is required Check with local area
Attachment D	DH 3204 Initiation of Services	A4	A version is required Check with local area
Attachment E	Notice of Privacy Practices	A5	A version is required Check with local area
Attachment F	DH 3203 Authorization to Disclose Confidential Information	A6	A version is required Check with local area
Attachment G	DH 2116 Consent to Fax	A7	Not Required Check with local area
Attachment H	Brochure and Application	A8	Required
Attachment I	Applicants Financial Survey	A9	Optional
Attachment J	Eligibility Staff Assessment Worksheet	A10	Required
Attachment K	Six Month Re-certification Review Form	A11	Required
Attachment L	Notice of Eligibility	A12	Required
Attachment M	Notice of Ineligibility	A13	Required
Attachment N	Notice of Rights	A14	Required
Attachment O	Insurance Waiver Form	A15	Required
Attachment P	Monthly Federal Poverty Guidelines	A16	N/A
Attachment Q	Annual Federal Poverty Guidelines	A17	N/A
Attachment R	Self Employment Tracking Sheet	A18	Required
Attachment S	Request for Exception	A19	Required
Attachment T	Request for Exception Monthly Tracking Log	A20	Required

Privacy Statement * Disclaimer
Accessibility Information * Email Advisory