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Apply for CAREAssist

CAREAssist is for HIV positive individuals who need financial help to pay for their HIV medications. CAREAssist can pay for medications and medical services for those who qualify.

Application materials are listed below. Please take a minute to review the Instructions. Most of the questions are easy to understand, but some may need an explanation. You may also have to gather information from your personal records to complete the application.

If you need help with any part of the application, please contact CAREAssist.

​English ​en español
Application Solicitud confidencial de CAREAssist
Instructions Instrucciones
HIV/AIDS Confirmation Form
Must be signed by a health care provider
Formulario de confirmación VIH/Sida
A ser llenada por el proveedor médico
CAREAssist Residency Verification
PDF
Word
Verificacion de residencia
PDF

Word
​​Note: The Residency Verification form is only needed when no Tier 1 or 2 documents exist.


Client Eligibility Review

A Client Eligibility Review (CER) must be completed every six months. Failure to complete and return the CER could delay or end your eligibility with the CAREAssist program.

English​ ​en español


Information Change Form

Use this form to report changes to legal name, family size, income, insurance, contact information and more. Please note, you may be able to report the change without using this form. Call CAREAssist for more information.

English​ ​en español
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Complaints and Grievances

It is the policy of the CAREAssist program to consistently respond to concerns voiced by clients about the administration of the CAREAssist program or policy issues regarding the program.

​English ​en español

CAREAssist Complaint and Grievance Policy

Procesos de queja formal e informal​
Grievance Policy and Form
Política y formulario de queja formal de CAREAssist​

Note: Concerns and complaints will be resolved in the least formal manner using a variety of approaches. Grievances must regard decisions, which affect a client's eligibility, amount, or length of time of assistance, and/or termination of assistance for program violations.​

Grievances may only be filed for (1) denial of eligibility to participate in the CAREAssist program (2) denial of a request for CAREAssist program assistance (3) denial of a request for exception, or (4) termination of assistance for program violations.​ ​


WellPartner Mail Order Enrollment

By using the mail order pharmacy, all of your medications (both HIV and non-HIV medications) will be mailed to your home or other location that you choose. If you use the mail-order pharmacy, you will still be able to use a local pharmacy to get urgently needed medication (like a short-term antibiotic).

You can register for the mail order pharmacy by calling WellPartner at 1-888-206-1605 or filling out a form:

​English ​en español
WellPartner Order Form WellPartner formulario para ordenar
Note: Once you have gotten your first prescription, you can register for an online account and request refills online.
​ ​

Medication Therapy Management

In partnership with Ramsell, CAREAssist is pleased to offer Medication Therapy Management (MTM) to eligible clients who are having difficulty adhering to medication regimens. MTM provides phone-based support to patients through direct adherence counseling with an HIV pharmacist. Both medical providers and Ryan White case managers can refer clients of concern to the MTM program.

For medical providers, use the MTM clinical providers referral form.

For Ryan White case managers, use the MTM case managers referral form.