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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

CA_PDF.pdfApplication

Solicitud confidencial de CAREAssist
PDF iconInstructions PDF iconInstrucciones
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 iconPDF
Word
Verificacion de residencia
PDF iconPDF
Word
Note: The Residency Verification form is only needed when no PDF iconTier 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

PDF iconCER Form and Instructions

PDF iconCER Formulario y Instrucciones


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

PDF iconInformation Change Form

Próximamente


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

PDF iconCAREAssist Complaint and Grievance Policy

PDF iconProcesos de queja formal e informal
PDF iconGrievance Policy and Form
PDF iconPolítica 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.


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 more information, please call the program at 971-673-0144.

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