Resources providing an overview of Medicaid eligibility, enrollment, and coverage for people with HIV, for use by RWHAP managers, staff, and enrollment assisters.
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.
ACE TA Center Resources
- Medicaid 101 for Ryan White HIV/AIDS Program Recipients and Providers
This tool is intended to help case managers understand the eligibility and enrollment rules for Medicaid, what the program covers, and how to ensure their clients can access the services they need. - How to Enroll Clients in Medicaid: Microlearning Module
This microlearning module outlines the basic eligibility criteria for health coverage through Medicaid, how to enroll in Medicaid, and the relationship between Medicaid and the RWHAP ADAP. The module also suggests other ACE TA Center resources for RWHAP staff and people with HIV to learn more about Medicaid coverage. - Understanding Dual Eligibility: A Guide for People with HIV About Medicare and Medicaid Coverage
This tool is intended to help people with HIV better understand the basics of dual eligibility for Medicaid and Medicare, as well as health coverage and financial assistance options for dually eligible RWHAP clients. This resource is also available in Spanish and Haitian Creole. - The Fundamentals of Medicare-Medicaid Dual Eligibility for Ryan White HIV/AIDS Program (RWHAP) Clients
This tool is intended to help case managers better understand the fundamental health coverage needs of their dually eligible clients, including how RWHAP and the ADAP work with Medicare and Medicaid coverage. - Dual Eligibility and Enrollment of Ryan White HIV/AIDS Program Clients: Microlearning Module
This microlearning module provides an update on what Medicaid/Medicare dual eligibility is, types of dual eligibility, the basic pathways by which a person becomes dually eligible, how to enroll dually eligible clients, and the role of the RWHAP ADAP. The module also suggests other ACE TA Center resources for RWAHP staff and people with HIV to learn more about resources to support clients who are dually eligible.
Additional Resources
- 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) #18-01 - Clarifications Regarding the use of Ryan White HIV/AIDS Program Funds for Health Care Coverage Premium and Cost Sharing Assistance
- Joint CMCS and HRSA Informational Bulletin (May 2013) - Coordination Between Medicaid and Ryan White HIV/AIDS Programs
- Kaiser Family Foundation - Medicaid and HIV Fact Sheet
- State Medicaid Income Eligibility Standards
