Ryan White Coverage and Eligibility

Am I eligible for the Ryan White Program?

You are eligible for Ryan White coverage if you:

• Are HIV positive

• In 2024: Have an annual household income of $75,300 for a one-person household; $102,200 for a two-person household, and so on.

• Are a Wisconsin resident

How do I get coverage?

• A clinic medical case manager will enroll you in the Ryan White Program if you are eligible. Ryan White is the payor of last resort, which means we will provide assistance with enrollment in other insurance options if possible.

• If you ever lose or have a lapse in your health insurance, please call (608) 263-0946 immediately for assistance in obtaining other coverage.

What does Ryan White cover?

The Ryan White Program covers the costs of medical care and support services for both uninsured and insured eligible individuals. If you are uninsured, the Ryan White Program will cover the primary charge for the service and you may be responsible for a small copay. If you are insured, the Ryan White Program will provide assistance with your copays, coinsurance and deductibles for eligible services.

Will I pay anything if I'm enrolled in Ryan White?

• If you are uninsured, you may be responsible for a small copay based on your individual income. See the fee scale (pdf)

• Please call us to update your income if it changes, so your copay amount is correct .

• We do not send these Ryan White copays to collections.

Questions?

Please call clinic medical case managers at (608) 263-0946.

Coverage

Medical services within HIV clinic ordered by HIV provider:

• HIV clinic visits with HIV medical provider

• Labs: CD4 count and viral load, resistance testing; Other diagnostic labs, tests, procedures or imaging ordered by HIV medical provider (including ultrasounds, CT scans, MRIs, lung function tests, bone mineral density scans).

• Cervical cancer screening

• Gynecology office visits for follow-up for abnormal cervical paps, including repeat cervical paps, colposcopies, and biopsies (cervical cancer treatment not covered)

• Anal cancer screening (anal cancer treatment not covered):

  • Annual anal pap done in HIV clinic

  • Referrals to colorectal surgery clinic for anoscopy/biopsy needed for follow-up of abnormal pap

  • Referrals to surgeon for consultation on Condyloma

• Screening and treatment for tuberculosis (TB)

• Screening and treatment for Hepatitis B and C

• Screening and treatment for sexually transmitted infections (STIs)

• Routine immunizations

• Primary care

• Urgent care

• Smoking cessation treatment

Other services within the HIV clinic:

• Medical case management provided by HIV clinical social workers

• Clinical pharmacy consultation provided in ID clinic

• Mental health screening and referral for treatment

• Addiction screening and treatment

• Condoms (external and internal) and lubricant

Medications:

• Antiretrovirals and other HIV related outpatient medications (primarily covered by ADAP program)

• Other outpatient medications, not covered by ADAP:

• Other outpatient medications prescribed by HIV provider, primary care provider, or psychiatric/addiction medicine provider filled at UW Health Pharmacy.

Services outside of the clinic:

• Psychiatric treatment provided by a UW Health psychiatrists and therapists

• Psychiatric treatment and groups provided by a Journey Mental Health Center (JMHC) psychiatric nurse practitioner and therapist. Covered if referral by HIV provider and scheduled by HIV social worker in designated clinic at JMHC.

• Medications filled at UW Health Pharmacy

• Colorectal surgery office visits for anoscopy and/or biopsy related to the follow-up of an abnormal anal pap result

• General surgery office visits related to the follow-up of an abnormal anal pap result, abnormal anoscopy or condyloma

• Dermatology visits related to the follow-up of HIV-related conditions or condyloma

• Gynecology visits for follow-up of an abnormal cervical pap result, including repeat cervical paps, colposcopies, and biopsies

• Nutrition clinic visits

• Ophthalmology visits for retinal exams and infections

• Urgent care visits if related to HIV

• Dental care is available at the Beloit Area Community Health Center or Vivent Dental Clinic

Non-covered services (referral to the UW Health Financial Assistance Program):

• In-patient hospital care

• Emergency department care

• Elective procedures

• Treatment for accidental injuries

• Outpatient surgeries

• Care that is not related to HIV or the treatments for HIV

Additional information