Apply for Ryan White services through Centralized Eligibility

If you are applying for program services or renewing for continued services please download and save a copy of the Notice of Privacy Practices, Rights and Responsibilities form (PDF) to keep for your records.

Ryan White program applications and renewals require you to submit proofs of income, residency, HIV status (if you are a new applicant), and Insurance information (if you have it). If you need to submit these at a later time, you can do so using the Ryan White Program Application online form, DHS-3539-ENG.

New applicants
Returning applicants
Emergency processing

New applicants

You are a “new applicant” if you have never applied to Ryan White or Program HH services in Minnesota or St. Croix and Pierce counties in Wisconsin.

The following verification documents are required for a complete application for all new applicants. If you do not provide the following verification documents, the processing of your application will be delayed:
- A signed note from your medical provider
- Verification of identity
- Verification of residency
- Verification of income
- Insurance information.
Download and complete the following forms and submit by one of the methods below:
- Ryan White New Applicant Form (PDF)
- Ryan White Annual Certification (PDF)
- Ryan White Healthcare Provider Request (PDF)
- Ryan White Verification of Employer Insurance (PDF), if you are employed
- If you have insurance, a copy (front and back) of your insurance card, if available.
To submit
- Mail: Minnesota Department of Human Services, P.O. Box 64972, St. Paul, MN 55164-0972
- Secure fax: 651-431-7414
- Online form: Use the Ryan White Program Application to submit your information electronically by choosing “New Client.”
Returning applicants

You are a returning applicant if you are returning to Ryan White or Program HH services in Minnesota or St. Croix and Pierce counties in Wisconsin.

Download and complete the following forms and submit by one of the methods below:
- Ryan White Annual Certification (PDF)
- Ryan White Verification of Employer Insurance (PDF), if you are employed
- If you have insurance, a copy (front and back) of your insurance card, if available.
To submit
- Mail: Minnesota Department of Human Services, P.O. Box 64972, St. Paul, MN 55164-0972
- Secure fax: 651-431-7414
- Online form: Use the Ryan White Program Application to submit your information electronically by choosing “Annual Renewal or Returning Client.”
Emergency processing

If you need emergency assistance to fill or refill your HIV prescriptions, Ryan White-funded 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.

If you need emergency processing and are new to the Ryan White Program, follow instructions for new applicants in the New applicants tab on this page. If you need emergency processing and are returning to the Ryan White Program, follow the instructions in the Returning applicants tab on this page.

A note on your clinic’s letterhead needs to be included, and signed by physician, nurse, physician assistant or a pharmacist stating that the applicant is applying under an emergency situation.

Then submit the forms and verification documents listed by fax to 651-431-7414.