The following resources are intended to provide RWHAP managers, staff, and enrollment assisters with an overview of Medicaid eligibility, enrollment, and coverage for people with HIV.
Medicaid and RWHAP
Medicaid is a joint state and federal program that provides health coverage to millions of Americans.
In recent years, Medicaid has grown to become the largest source of insurance coverage for people with HIV, providing preventive services, inpatient and outpatient care, and HIV prescription drugs to an estimated 42% of all adults with HIV in the U.S. (Kaiser Family Foundation, 2019).
In states that have expanded Medicaid coverage, people can qualify based on household income of 138% of the federal poverty level, alone. In states that have not expanded Medicaid coverage, people can qualify based on both financial and non-financial factors such as disability, and family status (e.g., having children, being pregnant).
However, Medicaid alone may not provide the full range of services that a person with HIV may require to support retention in care, medication adherence, and viral suppression. The Ryan White HIV/AIDS Program (RWHAP), including the AIDS Drug Assistance Programs (ADAP), can help by providing medical and support services which Medicaid does not cover (or only partially covers). The RWHAP, including ADAP, can also assist with Medicaid cost-sharing, in cases where such payments are required by the state.
It is important to keep in mind that the RWHAP is not health insurance, so RWHAP clients are strongly encouraged to enroll in Medicaid, Medicare, and/or private health insurance if they are eligible.
HAB Policy Clarification Notice (PCN) #13-01 - Clarifications Regarding Medicaid-Eligible Clients and Coverage of Services by the Ryan White HIV/AIDS Program
HAB Policy Clarification Notice (PCN) #13-06 - Clarifications Regarding Use of Ryan White HIV/AIDS Program Funds for Premium and Cost-Sharing Assistance for Medicaid
Joint CMCS and HRSA Informational Bulletin (May 2013) - Coordination Between Medicaid and Ryan White HIV/AIDS Programs