Apply for HIV programs and services

People with HIV can apply for assistance through Minnesota’s Ryan White Programs including Program HH. Program HH, administered by DHS, will help people access:

Dental services
Insurance premium assistance
Help paying for medication and medication copays (i.e. the AIDS Drug Assistance Program or ADAP)
Mental health services
Medication therapy management services.
Nutrition services.

Minnesota Ryan White Program services are available statewide to those who meet the following criteria:

A person who has received an HIV/AIDS diagnosis.
A resident of Minnesota.
A household with total income of less than 400% of the federal poverty guideline. For Program HH, income guidelines are updated annually on Feb. 1.

Additional program assessments can be made to determine eligibility for services if a person seeking services meets the above criteria and has no insurance or is underinsured. Underinsured means a person has insurance, but their insurance might not cover all HIV-related expenses.

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Apply for Ryan White services

If you need emergency assistance to fill or refill your HIV prescriptions, Program HH can process your application within 24 hours. Call the DHS HIV team at 651-431-2414 or 800-657-3761 (toll-free) to notify the team of incoming emergency documents. Then submit the forms and verification documents listed below by fax to 651-431-7414.

If you need emergency processing and are new to the Ryan White Program, follow instructions for a new applicant below. If you need emergency processing and are returning to the Ryan White Program, follow the instructions for a returning applicant below.

All applicants

The following verification documents are required for a complete application for all applicants. If you do not provide the following verification documents, the processing of your emergency application will be delayed.
- A signed note from your medical provider.
- Verification of identity.
- Verification of residency.
- Verification of income.
- Insurance information.
All applicants and enrollees updating their information, please download and save a copy of the Notice of Privacy Practices, Rights and Responsibilities form (PDF) to keep for your record.

New applicants

If you are new and have never applied to Ryan White or Program HH services in Minnesota, download and complete the following forms and submit via mail:
- Ryan White New Applicant Form (PDF)
- Ryan White Annual Certification (PDF)
- Ryan White Healthcare Provider Request (PDF)
- If you are employed, the Ryan White Verification of Employer Insurance (PDF)
- If you have insurance, a copy (front and back) of your insurance card, if available.
Or use this online form (PDF) to submit your information electronically by choosing “New Client.”

Returning applicants

If you are returning to Ryan White or Program HH services, please download and complete the following forms and submit via mail:
- Ryan White Annual Certification (PDF)
- If you are employed, the Ryan White Verification of Employer Insurance (PDF)
- If you have insurance, a copy (front and back) of your insurance card, if available.
Or use this online form (PDF) to submit your information electronically by choosing “Annual Renewal or Returning Client.”
Make an update to your program information

All applicants and enrollees updating their information should download and save a copy of the Notice of Privacy Practices, Rights and Responsibilities (PDF) for their records.

If you are enrolled in Ryan White or Program HH services and need to submit changes to your personal information, download and complete the Ryan White Information Change Form (PDF) and submit via mail.

Or use the online form to submit your information electronically by choosing “Information Change Form.”

If you are enrolled in Ryan White or Program HH services and need to make changes to your employment status or employment information, download and complete the following forms and submit via mail:
- Ryan White Information Change Form (PDF)
- Ryan White Verification of Employer Insurance (PDF)
Or use the online form to submit the information electronically by choosing “Information Change Form.”
Services available through our Ryan White Programs

More information about Ryan White services:

Program HH services
ADAP services
Additional Ryan White services

In additional to administering Ryan White programs, DHS also provides Ryan White funds to HIV service providers across the state. For more information about these services, see the HIV: Additional Ryan White services webpage.
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If you would like more information or assistance with your forms:
- Contact the DHS HIV team