Why is Ryan White HIV/AIDS Program (RWHAP) timely eligibility confirmation important? 

Timely Eligibility Confirmation 

Timely eligibility confirmation refers to the process of confirming that a previously enrolled RWHAP client is still eligible for RWHAP. For RWHAP recipients and subrecipients, this means checking client eligibility, specifically factors that may change over time (e.g., income, residence, or health care coverage) within a reasonable time frame. This timeframe is most commonly between six and 12 months, extending to 24 months in specific cases.  

How can RWHAP recipients and subrecipients develop timely eligibility confirmation policies to ensure continuity of care and reduce the client burden? 

RWHAP recipients and subrecipients are advised to conduct “periodic checks” for enrolled clients to identify changes in circumstances that might impact RWHAP eligibility within a reasonable timeframe (1).The current policy on RWHAP eligibility allows RWHAP recipients and subrecipients to set their own policies of eligibility confirmation within a reasonable timeframe. Some RWHAP recipients and subrecipients have used this new flexibility to put in place 12 to 24-month continuous enrollment policies. These extended timeframes were intended to address the chance of disenrollment among those who did not experience any residency or income changes, but faced challenges with eligibility confirmation within the six-month period.

RWHAP recipients and subrecipients deciding where to set their timely eligibility confirmation timeframe may consider the following:

• Ensure that timely eligibility confirmation is developed as part of a set of standardized policies on how to check eligibility.
• Evaluate benefits of expanding the eligibility timeframe, which may include reducing the administrative burden on the client and staff, providing continuity of care and uninterrupted services for clients, and reaching or maintaining viral suppression—which can help with HIV prevention in the wider community.
• Assess budget and staff implications of changing your timely eligibility confirmation policy, as longer timeframes may increase overall client enrollment numbers.
• Require clients to report life changes that would impact RWHAP eligibility.
• Incorporate check-ins with clients to stay aware of potential life changes. 

It’s important for RWHAP recipients and subrecipients to establish policies and procedures around timely eligibility confirmation once they decide on their timeframe. That way, the process is standardized and staff members can refer back to that guidance. 

Resources: 

1. Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB), PCN 21-02, Determining Client Eligibility & Payor of Last Resort in the Ryan White HIV/AIDS Program