Nevada’s Ryan White Programs Resource Directory

Eligibility and Enrollment Checklist

Categories: Documentation,  Enrollment

Proof Of HIV Diagnosis

All clients must provide upon initial enrollment only one (1) medical/legal document from the list below indicating HIV infection.

  • Western Blot
  • Letter on physician’s letterhead, with signature of MD, indicating that the applicant is HIV positive with diagnosis date.
  • Positive HIV immunoassay and detectable HIV RNA
  • Two positive HIV immunoassays (should be different assays based on different antigens or different principles)
  • Request for Proof of Diagnosis Form completed by applicant’s physician (CGD 15-39)

Proof Of Identification

All clients must provide upon initial enrollment only one (1) of the documents below. Driver Authorization Card is not allowable.

  • Can be expired
  • Nevada Driver’s License with Photo
  • US or Foreign Passport with Photo
  • Permanent Resident Card with Photo
  • Local, State, Federal Government issued card with Photo
  • Consulate Card with Photo
  • Resident Alien Card (U.S. citizenry not required) with Photo

Current Labs (Cd4 / Viral Load)

See below for required lab schedule

  • Initial & Annual Enrollment: CD4 T Cells and HIV Viral Load, no older than twelve months

Proof Of Nevada Residency

All clients must provide upon initial enrollment and annually
two (2) documents from the list below. Cannot be expired. Addresses must match.

  • Current lease/Rental Agreement
  • Rent/Mortgage Receipt (dated within the past 30 days)
  • Any Bill or Invoice (dated within the past 30 days)
  • Letter from a Government Agency
  • Voter Registration/Vehicle Registration
  • Prison Release Papers
  • Current Nevada Driver’s License or State ID Card
  • Consulate Identification Card
  • Resident Alien Card
  • Other verifiable government issued photo ID with address
  • Proof of property taxes paid
  • Verification of Residence (CGD 15-50)
  • Dependent Support Form (CGD 15-48)
  • Non-Stable Housing Declaration Form (CGD 15-44)

Proof Of Income Level

Proof of household income not to exceed 400% FPL based on their Modified Adjusted Gross Income (MAGI). Household income includes the income of anyone client claims on their taxes or the income of someone who claims client on their taxes. Provided upon initial enrollment and annually.

  • Copy of most recent pay stubs for the last month
  • Copy of most recent annual disability, SSI, retirement, pension, VA, child support/alimony, unemployment benefits, etc. statements
  • One (1) month of bank statements only if pay stubs or annual statements cannot be provided
  • Pre-paid debit card statements
  • Profit and Loss Statement from self-employment (CGD 16-04)
  • Verification of No Income (CGD 15-45)
  • Dependent Support Form (CGD 15-48)
  • MAGI Worksheet (CGD 15-52) REQUIRED

Proof Of Household Size

All clients must provide upon initial enrollment and annually all individuals they claim, may claim, or will claim in most current tax year.

  • Household Composition Form (CGD 16-03) REQUIRED

Existing Insurance Coverage

All clients must provide upon initial enrollment and annually proof of existing insurance (public or private) or a statement of no insurance. Clients requesting Insurance or Medication Assistance
will not receive services until this information is provided.

  • Survey of Existing Insurance Coverage (CGD 16-10) REQUIRED

Recertification – Every Six (6) Months

One of the following is acceptable at six month recertification: full application and documentation, self-attestation of no change or self-attestation of change with documentation

  • Six Month Self-Attestation of Ryan White Part ABCD Eligibility (GCD 15-46)
  • Proof of Nevada Residency (refer to this section)
  • Proof of Income Level (refer to this section)
  • Proof of Household Size (refer to this section)
  • Existing Insurance Coverage (refer to this section)

 

For case management into Ryan White Part B, please contact either persons below.

Samantha Penn, MBA
Management Analyst I
(Quality Assurance & Evaluation Analyst)
Phone: (702) 486-8103
Email: spenn@health.nv.gov

M. Thomas Blissett
Health Program Specialist I
(ADAP Coordinator)
Phone: (775) 684-4025
Email: michaelblissett@health.nv.gov