In this section, Ryan White providers can find the client intake, recertification forms, and support documents.
Idaho’s AIDS Drug Assistance Program (ADAP) helps people living with HIV or AIDS pay for prescriptions. Idaho’s ADAP formulary is updated as new medications are added and can be found here
Provider Prior Authorization forms can be found here
Cabenuva Provider Update - Prime Therapeutics will begin processing reimbursements for administration of Cabenuva injections and for related Cabenuva office visits on behalf of Idaho AIDS Drug Assistance Program (ADAP) clients. A claims form will need to be submitted with each reimbursement, a copy of the ID ADAP claims form can be found here. Related answers to Frequently Asked Questions can be found here.
More information about the Ryan White Program
The eligibility requirements for the AIDS Drug Assistance Program (ADAP) and the Ryan White Part B Medical Case Management include the following:
- HIV-positive
- Idaho resident
- Have income at or below 500 percent of the Federal Poverty Level
- Not insured or underinsured for medications and HIV monitoring labs
- Not an inmate of state or federal Corrections system
If your income is at or below 138% FPL, you may be eligible for Medicaid and should Apply for Medicaid | Idaho Department of Health and Welfare
| Family Size | Under 138% FPL |
| 1 | $20,782.80 |
| 2 | $28,207.20 |
| 3 | $35,631.60 |
| 4 | $43,056.00 |
| 5 | $50,480.40 |
| 6 | $57,904.80 |
*Medicaid may have additional eligibility requirements such as resource limits.
Core Medical Services: The Ryan White HIV/AIDS Program legislation specifies that the following 13 core medical services are allowable. Grantees must ensure that RWHAP Part B services are provided within the scope of the service category definitions provided by HRSA/HAB. Note: not all core medical services are funded by the Idaho Ryan White Part B program, funded core services are shown in bold.
1. Outpatient and ambulatory health services
2. AIDS Drug Assistance Program treatments
3. AIDS pharmaceutical assistance
4. Oral health care
5. Early intervention services
6. Health insurance premium and cost sharing assistance for low-income individuals
7. Home health care
8. Medical nutrition therapy
9. Hospice services
10. Home and community-based health services
11. Mental health services
12. Substance abuse outpatient care
13. Medical case management, including treatment adherence services
Support Services: The Ryan White HIV/AIDS Program legislation also provides for allowable support services. Grantees must ensure that RWHAP Part B services are provided within the scope of the service category definitions provided by HRSA/HAB. Note: not all support services are funded by the Idaho Ryan White Part B program, funded support services are shown in bold.
1. Case management (non-medical)
2. Childcare services
3. Emergency financial assistance
4. Food bank/home-delivered meals
5. Health education/risk reduction
6. Housing services
7. Legal services
8. Linguistics services (interpretation and translation)
9. Medical transportation services
10. Outreach services
11. Psychosocial support services
12. Referral for health care/supportive services
13. Rehabilitation services
14. Respite care
15. Substance abuse services—residential
16. Treatment adherence counseling
The Idaho Ryan White Part B Program is committed to assuring that no infringement of a client’s rights occurs at an agency funded by the program, and that there is an established procedure for addressing problems or complaints that clients may have. Clients participating in HIV medical case management and ADAP have the opportunity to voice their concerns or receive additional assistance if needed.