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RYAN WHITE PROGRAM

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ABOUT

General Overview

The Ryan White Program works with cities, states, and local community-based organization to provide HIV-related services to more than half a million people each year. The program is for those who do not have sufficient health care coverage or financial resources for coping with HIV disease. Ryan White fills gaps in care not covered by these other sources.
The majority of Ryan White funds support primary medical care and essential support services. A smaller but equally critical portion funds technical assistance, clinical training, and research on innovative models of care. It is administered by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), HIV/AIDS Bureau (HAB). Federal funds are awarded to agencies located around the country, which in turn deliver care to eligible individuals under funding categories called Parts,
The Ryan White legislation created a number of programs, called Parts, to meet needs for different communities and populations affected by HIV/AIDS. Each is described below.
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ELLIGIBILITY

Federal dollars from the Ryan White Treatment Modernization Act Part B and funds from the Bureau for Public Health’s Division of STD/HIV/Hepatitis (DSHH) Program  provide for the operation of the WV Ryan White Part B State Direct Services.  The DSHH Program contracts with the AIDS Task Force of the Upper Ohio Valley to administer the program.
The statewide services provides medical case management for all eligible HIV infected West Virginia  residents.  The case managers, located across the state,  provide case management, referrals, education, advocacy and act as access points in applying for emergency financial assistance.  The home office is located  in Wheeling.  The medical case managers rely on access points  across the state that refer clients for  case management or that request emergency financial assistance for clients in the agency’s  caseload.  Services supported by the State Direct Services are divided into six core areas.  The six core areas include case management, HIV primary care, HIV related medications, oral health, mental health and substance abuse treatment.
The State Direct Services Program serves approximately 900 clients annually.  The program collaborates closely with other Ryan White CARE Act funded programs to coordinate client services and to avoid duplication of services.  The program places a strong emphasis on accessing and remaining in HIV primary care.
The medical case managers also serve as access persons for clients who wish to acquire services through the other Part B programs:
To be eligible for State Direct services, participants must be:
  • A West Virginia resident
  • Certified in writing to be HIV infected
  • Have a current  income less than 250% of the current Federal Poverty Level
For more information see CONTACT

CARE AND SUPPORT

AIDS DRUG ASSISTANCE PROGRAM (ADAP)

AIDS Drug Assistance Programs (ADAPs) are state administered programs that provide HIV/AIDS medications to low-income individuals living with HIV disease who have little or no coverage from private or third party insurance. ADAPs were originally authorized by the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act, which was enacted in 1990, and reauthorized in 1996 and again in 2000. Currently, ADAPs are authorized under the Ryan White HIV/ADIS Treatment Modernization Act of 2006. The intent of state and federal legislation is to assure that ADAP funds are used only for the purchase of ADAP formulary drugs that cannot be paid for through other sources. ADAP must be the payor of last resort.
ADAP started as a Health Resources and Services Administration (HRSA) demonstration project to provide zidovudine (AZT), the first drug approved by Food and Drug Administration (FDA) to treat HIV infection. Since that time, ADAPs have significantly expanded to cover other FDA approved drugs to treat HIV infection and HIV-related opportunistic infections.
West Virginia AIDS Drug Assistance Program (ADAP) services are available to all eligible residents.  To be eligible, HIV infected residents with a family income less than 400% of the federal poverty level who are not eligible for other forms of reimbursement such as Medicaid or full insurance coverage (ADAP will cover co-pays for eligible residents with insurance) must complete the applications at the West Virginia Department of Health and Human Resources.
The last several years have seen an unprecedented growth in client demand and program costs for ADAP. This is due to:
  • The rapid expansion of the HIV/AIDS epidemic among low-income and uninsured populations;
  • The high cost of protease inhibitors and other antiretroviral medications that are used in multiple-drug regimens;
  • People with HIV/AIDS who are receiving therapy are living longer; and
  • The increasing numbers of people with HIV/AIDS seeking combination therapy as a result of widely publicized research that supports new pharmaceutical therapies for improving their health status and quality of life.
 

Medications and Formulary

INSURANCE CONTINUATION PROGRAMS

Ryan White Treatment Modernization Act Part B funds are used to fund the WV Health Insurance continuation Program for West Virginia’s HIV infected residents.
The program is designed to help eligible persons with HIV infection maintain their existing health insurance when they might otherwise lose their coverage because of financial stress, a reduction of work hours, an unpaid medical leave or a termination of their employment. The program does not pay for Medicare Supplemental insurance or Medicare premiums.
The Insurance Continuation Program is administered through a contract with the AIDS Task Force of the Upper Ohio Valley.  The ATF administration allows for timely payment of the insurance premiums, easy enrollment through the medical case managers located throughout the State and for maximum exposure and promotion of the program through contact with approximately 900 HIV infected West Virginians annually.  The ATF also relies on referrals from  AIDS service agencies and providers throughout the State.
To be eligible for the Insurance Continuation Program, a person must meet ALL of the following criteria.  Applicants must:
  • Be HIV infected (certified in writing in the application)
  • Live in West Virginia
  • Be covered by health insurance and be eligible for continuation coverage
  • Have a current family income that does not exceed 300% of the federal poverty guidelines
  • Have insurance that provides a minimum of pharmacy coverage equal to the the State ADAP formulary with cost effective neutrality compared to ADAP
  • Have insurance that demonstrates savings for the WV ADAP (analysis conducted  by HIV Care Coordinator quarterly)

CONTACT

Program Information

Information about HIV Care may be obtained by contacting Jay Adams:

Case Managers Information

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