Increase the percentage of 15-35 year-old PWH who have public or private health insurance to at least 85%

Pillar: Respond
Goal: Improve access to care and improve treatment for 75% of PWH by 2025.
Strategy: Increase the percentage of 15-35 year-old PWH who have public or private health insurance to at least 85%.
Target: 13–35 year-olds, Uninsured clients, Underinsured clients

Key Activities:

High Priority and Disruptively Innovative

  1. Identify financial resources that are available to assist patients with premium payments, co-pays, and other costs associated with HIV treatment.
  2. Train pharmacists to refer clients to benefits enrollment counselors when needed.
  3. Educate PWH or individuals at high-risk for HIV about important topics to consider when choosing coverage options.
    • Plans for formulary and pharmacy network.
    • Whether their chosen provider is in the coverage plan they select.
  4. Require HIV providers and Ryan White staff to coordinate timely enrollment in health coverage.
  5. Incorporate navigators to help PWH get private insurance. Use RW funds to purchase ACA insurance.
  6. Fund temporary staff who are Certified Application Counselors (CACs) in order to enroll clients in insurance through the ACA Marketplace.
  7. Host insurance enrollment fair during ACA Marketplace open enrollment to enroll clients in the Marketplace and in the Insurance Assistance Program. (Important: Have medical case managers on site to ensure client is Ryan White B certified so that client will receive funding).
  8. Also include COBRA insurance.
  9. Develop an enrollment process that includes ACA requirements during the time frame (end of Oct – end of Feb).
  10. Help individuals to get insured during the linkage-to-care process.
  11. Offer incentives to get individuals to complete insurance sign-up process during small enrollment window.
  12. Cultivate relationships with providers (public and private) to make it is easier for patients to get 90-day prescriptions and injections vs monthly.

Key Partners

Agency directors and managers, BCBS/ CIGNA, The Hill Hernando Church, CAC training curriculum, Center for Medical & Medicaid Services, Christ Community to help w/ insurance part (billable codes, etc.), Community Walgreens, Champion’s Pharmacy, Friends For Life, Greater Than AIDS project, Hope House, Greater Than AIDS, Kaiser Family Foundation, Local Ryan White committee members, Medical case managers, Memphis Health Center, Navigators from each organization and linkage to care, Regional One, Ryan White Part B, SCHD, SJCRH, Spirit Health, TDH

Potential Funding Sources

  • HRSA
  • Other public and private funding
  • Ryan White B Insurance Assistance Program
  • State and/ or local funding

Estimated Funding Allocation

  • Enrollment event; space, info/invitations, staffing, supplies, etc.- $5,000
  • Training-$5000
  • Additional part-time or seasonal enrollment staff-$25,000×3
    Total: $85,000


(Reported annually, locally monitored more frequently)

  • Consumer surveys
  • Ryan White audit
  • # of Ryan White clients enrolled for insurance

Monitoring Data Source