Ryan White HIV/AIDS Treatment Extension Act of 2009, Policy Notice 07-03 (PDF)

The Ryan White HIV/AIDS Treatment Extension Act of 2009 codifies a variety of core medical and support services provided to eligible people with HIV. The Minnesota Department of Human Services (DHS) directly administers Ryan White program services for eligible people with HIV under Program HH.

Program HH provides access to crucial medications and care services for people with HIV in Minnesota. It includes:

The Program HH Drug Benefit is also known as the AIDS Drug Assistance Program (ADAP). It is designed to maintain the health and independence of people with low income living with HIV in Minnesota by paying for antiretroviral and other prescriptions. Program HH’s Drug Benefit covers the full cost of medications for uninsured people or the cost of deductibles and co-pays for eligible people with certain types of public and/or private health insurance.

For information about the initial application process for people new to the benefit, refer to Program HH Policy Manual – Application process.

If the person is uninsured or does not have access to employer-sponsored insurance, they must apply to MNsure to determine the appropriate insurance coverage. MNsure determines eligibility for Medical Assistance, MinnesotaCare and qualified health plans. For more information, refer to MNsure – New customers.

If the person receives Social Security Disability Insurance and has earned income from wages or self-employment, they must apply for Medical Assistance for Employed Persons with Disabilities (MA-EPD) through the county/tribal nation in which they live. For more information, refer to CBSM – MA-EPD.

Program HH will pay the premiums for eligible people on MinnesotaCare and MA-EPD. Program HH will also pay premiums on approved MNsure qualified health plans, Medicare advantage plans or off-market plans. If eligible, a person may enroll in Program HH and receive services while awaiting a decision on applications for other coverage.

If Program HH approves the application, the effective date of Program HH coverage will be the first day of the calendar month Program HH received the application. Program HH staff will consider backdating coverage on a case-by-case basis if the person submits the request at the same time as the application and there is a compelling reason to do so. Program HH staff will not backdate an application by more than 90 days.

The Program HH Drug Benefit has an open medication formulary that outlines the specific drugs that are covered. The formulary includes pharmaceutical agents from all of the classes approved in the federally approved guidelines for the use of antiretroviral agents in adults and adolescents living with HIV.

DHS – Program HH Medication Program (ADAP) Formulary includes the program’s formulary, as well as information on how to submit a request for a medication to be added to the formulary.

Note: The Program HH (ADAP) Formulary does not allow for prescribed narcotics.

The Program HH Drug Benefit covers the full cost of medications for uninsured people or the cost of deductibles and co-pays for eligible people with certain types of public and/or private health insurance.

People enrolled in Program HH who use the Drug Benefit are required to use a pharmacy that is enrolled through the Minnesota MMIS billing system as a Minnesota Health Care Programs (MHCP) pharmacy. Program HH is not responsible for paying claims to pharmacies that are not enrolled as MHCP pharmacies.

For information about the recertification process, refer to Program HH Policy Manual – Application process.