Ryan White Services Clinical Services (Outpatient Ambulatory Medical Care) Case Management Services Behavioral Health Services Self-Management Program RW Program Eligibility (Link to RW Eligibility Information) Documentation to verify HIV Status Documentation of Income (must be at or below 300% of the Federal Poverty guidelines) Documentation of Residency (must be within the Eligible Metropolitan Area) Documentation to Verify Participation in Primary Care HICP/ADAP Services (Link to HICP and ADAP eligibility information) You will need to provide on the day of your appointment: For All Applications: Identification Proof of residency Proof of income (30 days’ worth of current income) For HICP Application Only: Current Premium Statement (Medical, Dental and Vision) – must include amount of premium and payment address Summary of Benefits (Medical, Dental and Vision) Policy must be active with premium current Your Medical Provider will need to: Provide Viral load lab results (no older than 5 months) Provide CD4 lab results (no older than 5 months) Complete Case report ART Hx and Physician Information (Page 4 of the application) Complete Medical Verification Page (part of intake application) HOPWA-Funded Financial Assistance Programs (Link to HOPWA eligibility) Medical Verification of HIV/AIDS diagnosis Demonstration of Need – Financial plan must be completed and show evidence of applicants inability to make payment. Need is temporary – Must demonstrate that a one-time financial intervention (STRMU/SDAP); or short-term financial support (TBRA) will significantly minimize the situation. Must be able to demonstrate that they will be able to meet future expenses by submitting documented proof of future income, and/or increased income plan and a budgeting plan. Transportation Assistance (Link to eligibility requirements) Documentation to verify HIV status Documented income at or below 300% of the Federal Poverty guidelines Live within AID Atlanta’s service area Must also demonstrate that the need for transportation assistance is related to accessing healthcare or housing. This may include access to job related activities that stabilize income and directly impacts ability to maintain housing.