Bluegrass Care Clinic

Eligibility Requirements

Eligibility Requirements

Ryan White Part C & D*

Applicants must meet all of the following requirements:

1. Be HIV positive.
   
2. Provide complete name-linked verification of HIV+ status within 30 days of the initial interview. One of the following may be used to verify HIV status.  

• Positive Western Blot Result

• Signed and dated written statement from a medical care provider (Please use the medical documentation form)

• A Counseling and Testing provider may sign and verify HIV status

• A discharge summary or other hospital record that verifies diagnosis

• Medicaid or Social Security document that verifies diagnosis

3. Provide verification of a full year of household income. Income must be verified for the applicant and any wage earning household member (if applicable) by one of the following:

• Pay stubs that represent a full year of income

• Most recent W-2 form

• Award letter from Social Security Disability/Supplemental Security Income

• Check stub from Social Security Disability/Supplemental Security Income

• Signed statement of no income (for applicants whom report having no income)

• If applicant has zero income, he/she must report how needs of daily living are being met.

4. Proof of residency:

• Valid Kentucky driver’s license or state identification card
  

• Copy of signed lease agreement
  

• Current utility bill
  

• Statement from person providing room and board

         5.   Sign and date the Informed Participation Agreement form.

         6.   Provide sufficient factual information to complete the initial intake and assessment form within
         30 days of the initial interview.

         7.   Provide documentation of health insurance (including Medicaid/Medicare and private
         health coverage), if applicable.

*Patient eligible for the Ryan White Part D program are: Women, Infant, Children, and Youth (under the age of 24) as well as affected family members of HIV –positive persons.