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AIDS Drug Assistance Program (ADAP)
What is ADAP?
The AIDS Drug Assistance Program (ADAP) is available to HIV-positive
people with limited income and assets. Four different programs
offered by ADAP are: ADAP, ADAP-Plus, HIV Home Care Program and
the APIC (ADAP Plus Insurance Continuation) program. ADAP pays
for many HIV prescription drugs. ADAP-Plus pays for doctor visits
and labs (like bloodwork). The HIV Home Care Program pays for nurses
and home attendants who can assist you if you are homebound. The
APIC program pays for private health insurance. A separate GMHC
fact sheet describes the APIC program.
What types of coverage does ADAP offer?
ADAP's prescription drug coverage includes medications that directly
fight HIV (antiretrovirals) as well as drugs that fight the various
infections that occur in HIV-positive people (such as PCP pneumonia).
ADAP also pays for certain pain medicines, medicine that relieves
diarrhea, drugs that relieve side effects of HIV medications, and
certain psychiatric drugs. If you have a prescription for a nutritional
supplement (like vitamins and minerals), ADAP may also pay for
it. GMHC's advocacy unit has a complete list of drugs and supplements
that ADAP covers.
If you check the ADAP-Plus box on your application and have no
other health insurance, ADAP can pay for visits to medical clinics
if they accept ADAP. Always make sure that your medical provider
accepts ADAP before you receive services. Visits
to primary care physicians and specialists are covered. Lab work
or related medical procedures may be covered only if they are part
of your clinic visit. ADAP can also pay for mental health therapy
(up to 24 visits per year) as well as routine dental care.
ADAP's Homecare program will pay for skilled nurses, home health
aides, homemakers, nutritional counselors, injections, and durable
medical equipment such as wheelchairs. There is a $30,000 lifetime
limit on homecare services.
What types of medical expenses will ADAP not cover?
It is important for you to know that some important medical services
are not covered by ADAP. The biggest of these expenses is in-patient
hospitalization. ADAP will also not cover any type of medical bills
incurred before the date of ADAP enrollment. Emergency room visits
are not covered by ADAP. Many prescription drugs, particularly
those not related to your HIV, are also not covered by ADAP. Check
the list of covered drugs in the ADAP application. Also not covered
are treatment for alcoholism and drug addiction, physical rehabilitation
services such as physical therapy and speech therapy, counseling
related to HIV testing, and case management.
Where is ADAP accepted?
There are a number of enrolled clinics, hospitals, laboratory
providers, private doctor offices, pharmacies, ambulatory care
providers as well as home health care agencies who accept ADAP
and ADAP Plus throughout New York State.
How do I know if I am eligible for ADAP?
Your eligibility for ADAP depends on your medical and financial
status. If you are HIV positive and a medical provider can verify
this information, then you meet the medical criteria. If you have
a household of one, the gross income limit is $44,000 per year;
$59,000 for a household of 2; and $74,400 for three or more. There
is a liquid asset limit of $25,000; pre-tax retirement savings
will be counted as 50% of the cash value towards this limit.
How do I apply?
Documentation verifying your income (i.e., benefit award letter
and/or paystubs), residency (i.e., New York State I.D. or utility
bill), assets (i.e., current bank account statements), and health
insurance, if applicable (i.e., insurance card) needs to be submitted
with the ADAP application. The blue ADAP medical report form needs
to be completed by a physician and sent to ADAP before an application
can be approved. The application and documentation can be faxed
to ADAP; however, they require the original copy of the medical
report in order to activate your coverage.
What happens when I am approved?
ADAP will send you written notification and an ADAP card in the
mail. Once you have received your ADAP card, you can immediately
access coverage and treatment.
Questions?
The toll-free ADAP number to call is 1-800-542-2437.
The Client Advocacy Unit at GMHC is available to assist
you. For more information, please call our Helpline: 212/367-1125,
Wednesday 2 pm to 5:30 pm. Walk-in services are available Tuesdays and Thursdays, 10 am to 1 pm.
Revised 3/07
© 2007 Gay Men's Health Crisis
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