Case management has been essential to many people living with HIV. Case managers have helped people access medical care, housing, emergency financial assistance, food, clothing, support and mental health/substance abuse treatment programs. They are familiar with community resources and can serve as guides through the complicated systems that HIV-positive people have to negotiate. Unfortunately, although the needs of HIV-positive people are increasingly complex and urgent, major funding for services is remaining flat at best. Stresses on the Ryan White system of care are resulting in changes in services from state to state. For instance, some states have enacted various restrictions on the availability of their AIDS Drugs Assistance Programs (ADAP), instituting waiting lists or limiting medication options. In the Atlanta metropolitan area, there will soon be significant changes in the goals, approach and process of case management services.

Throughout 2004, consumers and providers of HIV case management and medical services in the Atlanta area met to develop standards for case management funded by the Ryan White CARE Act. They were concerned with how to use limited funds to achieve maximum results for a growing population. The new standards and system they have set up will go into effect May 1, 2005.

While some consumers may choose to contact a case management agency such as AID Atlanta on their own, many others are referred through AIDS service organizations, clinics and hospitals. Under the new case management standards, representatives of many referring agencies will screen people to help them determine if they may be eligible for case management services. Ryan White-funded agencies that commonly refer clients for case management will use a screening tool to enable them to make appropriate referrals and to educate consumers about what they need in order to access these services in the most direct manner.

In order to qualify for any Ryan White-funded service, an individual must first provide documentation proving that they are HIV positive, their county of residence and their income. It is essential that potential clients bring proof of these three qualifiers with them when they present for case management.

The primary goal of Ryan White-funded case management is to promote access to health care, so the new standards require consumers to be actively enrolled in primary medical care. For adults, active enrollment is defined as at least one visit with a primary care provider every six months. Clients enrolled in case management will not have to be in health care in order to register for case management, but they will need to get themselves into primary care in the first six months in order to maintain their eligibility for case management services.

Consumers who meet the initial eligibility requirements will be further assessed for their psychosocial situation and needs. Based on this assessment, some consumers may be found to not qualify for case management. These people will then be given resource packets to enhance their familiarity with community resources. People who are assessed to be at this level who need access to ADAP will be able to apply for that without enrolling in case management. Education and other support services -- such as AIDS Survival Project's programs -- may be suggested for people who don't qualify for case management but who do need or want to develop skills to enhance their ability to manage the impact of HIV on their life.

Consumers who qualify for more assistance will work with their case manager on developing a plan toward self-management with the ultimate goal of "graduation" from case management. Common goals for people who qualify for one of the higher levels of case management include establishing steady medical care and adherence, secure housing, a stable income, adequate support networks, and management of mental health and substance abuse issues. Together, the case manager and client will develop an individual service plan aimed at taking concrete steps that will allow a client to be self-sufficient. Rather than a focus on crisis management, the new role of Ryan White-funded case management is skills-building and empowerment with a focus on supplementing what a client already has and building on that through the partnership of client and case manager.

The new standards set out specific criteria for the minimum level of contact a case manager and client need to have. Toward the goal of using limited resources conservatively, the standards also describe the various circumstances under which case management services will be terminated, how records are to be maintained and what the qualifications are to be employed as a Ryan White case manager.

If you or someone you know is concerned about access to a case manager or how these new standards may have an impact, call your local case management agency. In Atlanta, that would be AID Atlanta at (404) 870-7800. The new standards can be found online at AIDS Survival Project peer counselors will be able to answer questions about the screenings for case management eligibility as we approach the May 1 initiation date.