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The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

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Eligibility Information

HIV/AIDS

ELIGIBILITY  INFORMATION FOR
HIV/AIDS PATIENT CARE PROGRAMS

This website presents eligibility requirements and procedures, which are the same for the following programs.  

Acrobat Reader* please note all files open in a new window and are less than 5mb in size.

(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, HIV/AIDS and Hepatitis Section.

The Federal Poverty Guidelines provide a measure of poverty. They are updated annually in the Federal Register by the Department of Health and Human Services. The guidelines are a simplification of the poverty thresholds when determining financial eligibility for certain federal programs.  The Federal Poverty Level (FPL) is used by the HIV/AIDS and Hepatitis Program to determine the maximum amount of income allowed for eligibility.

For general questions about the FPL, visit http://aspe.hhs.gov/poverty.

(A) The Eligibility Requirements (doc 24KB)   
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 English
Eligibility Brochure Spanish
Eligibility Brochure Creole 
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
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 236KB)   
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) Attachment Rule 64D-4 memo (pdf 893KB)

Attachments

Attachment to Eligibility Manual A through F
All files are pdf/doc format and under 5mb in size. All files open in a new window

Attachment

Name

Requirement

List of Attachments

Attachment Summary

N/A

Attachment A

Ryan White Program Service Definitions

N/A

Attachment B

DH 1120 Computer Use and Confidentiality Agreement

A version is required
Check with local area

Attachment C

DH 3204 Initiation of Services

A version is required
Check with local area

Attachment D1

Notice of Privacy Practices

A version is required
Check with local area

Attachment D2 Notice of Privacy Practices Acknowledgment Form
A version is required
Check with local area

Attachment E

DH 3203 Authorization to Disclose Confidential Information

A version is required
Check with local area

Attachment F

DH 2116 Consent to Fax

Not Required
Check with local area

Attachment G

Brochure and Application

Required

Attachment H

Eligibility Staff Assessment Worksheet

Required

Attachment I

Six Month Re-certification Review Form

Required

Attachment J

Notice of Eligibility

Required

Attachment K

Notice of Ineligibility

Required

Attachment L

Notice of Rights

Required

Attachment M

Insurance Waiver Form

Required

Attachment N

Federal Poverty Guidelines

N/A

Attachment O

Self Employment Tracking Sheet

Required

Attachment P

Request for Exceptions

Required