HIV programs and services

If you are new to Ryan White or Program HH services, please download and complete the following forms:

• Ryan White New Application/Information Change
• Ryan White Annual Certification
• Ryan White Healthcare Provider Request
• Ryan White Verification of Employer Insurance (if you are employed)
  • Please include a copy (front and back) of your insurance card if available.

Please also download and save a copy of the Ryan White Program Notice of Privacy Practices Rights and Responsibilities to keep for your records.

If you are returning to Ryan White or Program HH services, please download and complete the following forms:

• Ryan White Annual Certification
• Ryan White Verification of Employer Insurance (If you are employed)

Please also download and save a copy of the Ryan White Program Notice of Privacy Practices Rights and Responsibilities to keep for your records.

If you are enrolled in Ryan White or Program HH services, and it’s time for your Annual renewal or Six-Month recertification, please download and complete the following (applicable) forms:

• Ryan White Annual Certification
• Ryan White Six-Month Recertification *Please note you can also submit this form online.

Please also download and save a copy of the Ryan White Program Notice of Privacy Practices Rights and Responsibilities to keep for your records.

If you are enrolled in Ryan White or Program HH services and need to submit any demographic changes, or changes to your employment, please download and complete the following (applicable) forms:

• Ryan White New Application/Information Change
• Ryan White Verification of Employer Insurance (If you are employed)
  • Please include a copy (front and back) of your insurance card if available.

Please also download and save a copy of the Ryan White Program Notice of Privacy Practices Rights and Responsibilities to keep for your records.

Dental services pays for routine diagnostic, preventive and corrective dental procedures furnished under the supervision of an approved dentist.

There are many options available, including:

• Individually purchased policies through the open market
• Qualified Health Plans through MNsure
• Medicare supplement policies
• Some employer sponsored insurance plans

The medication program provides HIV-related prescription drugs to uninsured and underinsured individuals living with HIV.

Mental health services gives you an opportunity to have assistance with receiving proper mental health care.

Nutrition services pays up to $100 each month for enteral/nutritional supplements when ordered by a physician.