Eligibility for the HIV/AIDS Medications Program

PURPOSE: This rule establishes the requirements for assistance from the HIV/AIDS Medications Program. (1) Individuals may be admitted to the program at any time during any stage of Human Immunodeficiency Virus (HIV) infection. (2) Individuals may be provided assistance by the medications program only pursuant to available funding, as delineated in 19 CSR 20-43.020. An individual is eligible if s/he meets the following criteria: (A) Is a Missouri resident; (B) Is not incarcerated in a state correctional facility nor an inpatient in a licensed heath care facility as defined in Chapter 197, RSMo; (C) Is HIV infected and has provided written medical evidence of HIV status to a service coordinator; (D) Is enrolled in the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) service coordination program; (E) Has an income at or below three hundred percent (300%) of the federal poverty standard published annually in the Federal Register by the U.S. Department of Health and Human Services. A client shall provide updated documentation of income and other medications assistance from other sources such as private insurance, other third-party insurance or Medicaid annually, or at any time when requested by the department or its contractors; and (F) Is ineligible for medications assistance from other sources such as private insurance, other third-party insurance or Medicaid. (3) If an individual meets the requirements of subsections (2)(A) through (F), but available funding is insufficient to provide assistance, they will be placed on an access list. (A) Individuals will be removed from the access list and will begin to receive assistance as funding becomes available. (B) Individuals residing in rural counties will be given priority for being removed from the access list to receive medications assistance. (C) Within the classification of rural or urban counties, individuals who have been on the access list the longest time will be given priority. (D) Within the urban classification of urban counties, the department will collaborate with Title I grantees to assure client medications access at the local levels. (4) A client may be terminated from the medications assistance program for any of the following reasons: (A) A client shall be terminated from the medications program at any time that he/she no longer meets all program eligibility requirements described in subsections (2)(A) through (E) above. 1. It shall be the responsibility of the client to inform the department or a service coordinator if he or she no longer meets any one (1) or more of the program eligibility requirements and initiates an application for assistance through the service coordination system. 2. A client terminated from the medications program due to no longer meeting program eligibility requirements may be readmitted to the program at such time as the client again meets all program eligibility requirements; and (B) A client who knowingly provides false information or fails to meet applicable statutes and regulations may be terminated from the program at any time. AUTHORITY: sections 192.006, RSMo Supp. 1998 and 192.020, RSMo 1994.* Previously filed as 19 CSR 40-13.030. Emergency rule filed Nov. 21, 1996, effective Dec. 1, 1996, expired May 29, 1997. Original rule filed Dec. 10, 1996, effective May 30, 1997. Moved to 19 CSR 20-43.030 and amended: Filed Jan. 14, 1999, effective Aug. 30, 1999. *Original authority: 192.006, RSMo 1993, amended 1995 and 192.020, RSMo 1939, amended 1945, 1951. Communicable Disease Prevention