Centralized Eligibility means instead of each agency that serves a client having to process eligibility, a designated agency or set of agencies does it for them. The centralized eligibility model allows other agencies to focus on the client rather than documenting eligibility. It also makes it easier for clients to receive services at multiple providers and prevents them from falling out of care.
The Ryan White grant requires clients to provide proof of income, proof of residency, proof of HIV diagnosis and proof of insurance if applicable. As clients navigate through the system, they may be referred to other Ryan White service provider. Each service provider will have to do their due diligence to ensure the client is eligible for Ryan White services. If a client lives in a state that does not have a centralized eligibility model, they will be required to provide their eligibility documentation to each Ryan White provider they receive services from. The difficult part is clients may have different renewal dates with each provider. This can be extremely hard to keep track of and manage for clients. It can lead to clients falling out of care and loss of life saving treatment. In addition, the staff that serve the client can also experience challenges with collecting renewal documents and entering data which takes away from the time with the client.
A solution to this issue is moving to a centralized eligibility model. Centralized eligibility can be done at one location only or multiple locations. The Case Manager or Medical Case Manager may collect the eligibility documentation from the client and forward it to the Central Eligibility Office or the client can send it in directly to be processed. This also helps with quality control because the trained centralized eligibility staff will process and determine eligibility using the same methodology which prevents discrepancies.
We here at TriYoung, Inc. have experience with the centralized eligibility model. We have worked with several states to implement our centralized eligibility system called Ryan White Integrated Statewide Eligibility (RWISE). RWISE is a program that sits on top of CAREWare which allows for reporting and prevents duplicate data entry.
If you are interested in learning more about centralized eligibility, please feel free to contact us.