Ryan White Part B Eligibility Assessment

Hotline 1-800-825-3518

The Illinois Ryan White Part B Program is authorized under the Ryan White CARE Act and is administered by the Illinois Department of Public Health (IDPH). The purpose of this program is to provide HIV positive individuals who reside in Illinois and who are low-income, uninsured or under insured with access to a wide variety of core and supportive services. Below are some of the services that are offered through this program to those who qualify.

Prescription Assistance

Prescription Assistance services are designed to provide assistance with and access to HIV/AIDS medications that are on the approved Ryan White Part B Formulary list.

Premium Assistance

This service is designed to assist individuals with payment of their health insurance premiums up to $750 per month for approved plans by the Ryan White Part B Program.

For information on the 2019 Open Enrollment for the Illinois Insurance Marketplace and the approved insurance plans, please click on one of the links below.

2019 Open Enrollment Letter – Insured, Uninsured or ACA Eligible Español English

2019 Open Enrollment Letter – Not Eligible for IL Marketplace Español English

Care Services

These services include assistance with primary medical care, medical case management, mental health, dental care, transportation, housing, and other core and supportive services to assist the individual in maintaining good overall health.

Applying for Services

To receive any of the services available through Ryan White Part B Program, you must complete an Eligibility Assessment. This assessment will collect all information and supporting documentation needed to determine your eligibility for the program.

Please note that IDPH has taken into account the highly confidential information that you will be providing on this website and has taken steps to ensure this site is secure and meets all security requirements specified under HIPAA as well as the state AIDS Confidentiality Act.

For instructions on how to complete the Eligibility Assessment, click here.

To complete an Eligibility Assessment, please click here.

To check the status of a previously submitted Assessment, please click here.

The Illinois Ryan White Part B Program requires supporting documentation regarding your residency, household income, and a signed Authorization to Release. To download these documents, please click on the links below.

Authorization to Release

Privacy Practice

Verification of Residency

Household Income Statement

Affidavit of No Insurance Coverage

Tax Payment Authorization

ADAP Formulary and Prescribing Guidlines

Contract Pharmacy Incident Form

Prior Authorization for Hepatitis C

Prior Authorization for Atovaquone (Mepron)

Prior Authorization for Enfurvirtide (Fuzeon)

Prior Authorization for Valganciclovir hydrochloride (Valcyte)

Prior Authorization for Hormone Therapy

Prior Authorization for Trogarzo

User Accounts

You can sign up for a user account to drastically decrease the time spent reapplying for services and to receive more options on receiving email or text message alerts when it is time to reapply.

For instructions on requesting a Web User Account, click here.

For a copy of the Web User Account Agreement, click here.

To log in with your issued Web User Account, click here.

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