Virginia AIDS Drug Assistance Program (ADAP)

The Virginia (VA) AIDS Drug Assistance Program (ADAP) provides access to life-saving medications for the treatment of HIV and related illnesses for low-income clients through the provision of medications or through assistance with insurance premiums and medication co-payments. The program is primarily supported with federal Ryan White (RW) Treatment Extension Act Part B grant funding, which is distributed by a formula based on living HIV and AIDS cases to all states and territories in the United States. VA ADAP provides insurance cost support or directly purchased medications through four service options: Direct ADAP, the Medicare Part D Assistance Program (MPAP), the Insurance Continuation Assistance Program (ICAP) and the Health Insurance Marketplace Assistance Program (HIMAP).


ADAP Enrollment Numbers (as of February 2019)

  • Direct ADAP: 1,922
  • Medicare Part D Assistance Program (MPAP): 719
  • Insurance Continuation Assistance Program (ICAP): 832
  • Health Insurance Marketplace Assistance Program (HIMAP, clients in ACA): 3,140
  • Medicaid Expected: 1,014
  • Medicaid Confirmed: 1,528

Hepatitis C/HIV Co-Infected Treatment Assistance Program Enrollment Numbers (as of April 2018)

  • Number of clients that have accessed program: 94
  • Number of clients that have completed treatment: 85
  • Number of clients in treatment: 3

Clinical Support and Policy Development

In 1996, an ADAP Advisory Committee was created. The committee is comprised of HIV/AIDS medical providers, a pharmacist, and consumers. The committee advises VDH on changes to the formulary, changes in eligibility criteria, adherence issues, and educational concerns. The committee reviews data on ADAP utilization and assess budgetary implications of trends and program changes.

For more information about the committee, please see the ADAP Advisory Committee Scope.



Questions or comments?  Medication Eligibility Hotline 1-855-362-0658

 

VDH/DMAS Announcements

Please read these updates and help us with the listed action steps. If you have any questions, please call the VDH Medication Hotline at 1-855-362-0658.


Medicaid Expansion Enrollment Updates

March 2019

If ADAP paid your Affordable Care Act (ACA) Marketplace Health Insurance Plan premiums and medication co-payments in 2018 and now you may have Medicaid, read carefully to learn more about how to get your medications in 2019. Contact the ADAP team at 1-855-362-0658 if you have questions

If you are newly enrolled in Virginia Medicaid, you need to go to Healthcare.gov at https://www.healthcare.gov/ or call 1-800-318-2596 (TTY: 1-855-889-4325) and stop your ACA Marketplace plan.  If you do not take this action, your ACA Marketplace plan may have been automatically renewed for 2019, but now you will not get help with costs.  ADAP stops paying your premiums and medication co-pays because you can get your medications using Medicaid.  Please send a copy of your Medicaid letter or card to Virginia Department of Health, James Madison Building, 1st floor, 109 Governor Street, Richmond, VA 23219 or fax to (804) 864-8050.  Call Benalytics at 855-483-4647 if you need help cancelling your ACA Marketplace plan.  Begin using your Medicaid insurance card to get your medications and health care services.

If you received a notice stating that your Medicaid application has been referred to Virginia for review, you are being evaluated for Medicaid benefits. Continue your ACA Marketplace plan until you receive a final decision from Virginia stating that you are eligible for Medicaid. ADAP keeps paying your premiums and medication co-pays until you are enrolled in Medicaid. Please mail a copy of your ACA Marketplace premium information and card to Virginia Department of Health, James Madison Building, 1st floor, 109 Governor Street, Richmond, VA 23219 or fax to (804) 864-8050.

If you have not received mail from Virginia Medicaid, or it has been misplaced, call the Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590). Their hours are Mon - Fri: 8:00 am to 7:00 pm and Sat: 9:00 am to 12:00 pm.  They can answer any questions you may have about your plan status.  You can also go to their website at coverva.org.  If you are having a hard time accessing medications or medical services, reach out to your Medical Case Manager, Social Worker or other advocate for help.

If the final decision from Virginia is that, you are NOT eligible for Medicaid, continue your ACA Marketplace plan and update your Marketplace application with any changes (such as a change in your household size or income). If you already ended your ACA Marketplace plan, you may qualify for a Special Enrollment Period to enroll in ACA Marketplace coverage with financial assistance.  Go to Healthcare.gov at https://www.healthcare.gov/  or call 1-800-318-2596 (TTY: 1-855-889-4325) to update your Marketplace application or apply during a special enrollment period.  You have 60 days from the date of your denial of Medicaid eligibility to enroll using the Special Enrollment Period, if eligible.  Please mail a copy of your Marketplace premium information and card to Virginia Department of Health, James Madison Building, 1st floor, 109 Governor Street, Richmond, VA 23219 or fax to (804) 864-8050 so that ADAP can continue paying your premiums and medication co-pays.

For questions about Medicaid, call Cover Virginia Call Center at 1-855-242-8282 (TDD: 1-888-221-1590). Virginia Department of Social Services Enterprise Call Center at 1-855-635-4370 can also help with Medicaid and other benefits.

December 28, 2018

Are you ready for Medicaid Expansion?  Visit this page frequently for the latest enrollment updates.

Virginia Medicaid Expansion Enrollment Resources

The Department of Medical Assistance Services (DMAS) has posted the following informational updates regarding Medicaid Expansion:

  • December 19: Medicaid cards mailed to new members
  • December 26: Letters sent assigning new members to health plans, giving them 90 days from January 1 to decide whether to keep that plan or choose a different one
  • January 1, 2019: Coverage begins for newly eligible adults

November 21, 2018

You and your family might qualify for Virginia Medicaid’s new health insurance.  The new health benefits start on January 1, 2019.  Virginia Medicaid sent letters in yellow and white envelopes to people who will get this new insurance.  If you have Plan First and GAP, Medicaid will automatically enroll you.  If you have SNAP or are a Parent of a Child with Medicaid, you can answer three easy questions to sign up.  Cover Virginia can help you sign up online https://www.coverva.org/expansion or phone at 1-855-221-1590.  TDD users dial 1-888-221-1590.  If you got a letter from Medicaid but lost it, Cover Virginia can tell you whether Medicaid sent you a letter.  You can sign up for this new Medicaid insurance any time!

If you had Marketplace insurance last year, you might qualify for this new low to no-cost insurance that will cover your medicines, your doctor and lab visits, and other services.  Call Benalytics at 855-483-4647 and they can help you find out which insurance you can get and help you enroll.

Not sure which steps to take?  Call the ADAP Hotline at 1-855-362-0658.


Please read these updates and help us with the listed action steps. If you have any questions, please call the VDH Medication Hotline at 1-855-362-0658.


ACA Enrollment Updates

March 2019

If you have Anthem coverage, Anthem sent out new cards with a new Bank Identification Number/BIN (BIN 20099). This six-digit number tells the computer database at the pharmacy which health insurance provider is to receive the claim for your prescription. Several people are reporting that the new BIN not working. Anthem confirmed this may be true for some clients, and is working to fix it. Until this problem is fixed, the retail pharmacy should try both the old BIN 003858 and new BIN 020099. As Anthem updates VDH, we will post them to our website. If you are experiencing this issue, please call the medication access hotline at 1-855-362-0658. Clients who are not able to fill using both BIN numbers may qualify for a 30-day temporary fill.

VDH is getting a large volume of 2019 insurance billing statements for Medicaid-eligible clients for the 2019 open enrollment period. For VDH to pay premiums for ACA plans, the following action must be completed:

  • VDH must have an official Medicaid denial for that client, meaning you are determined to NOT be eligible for Medicaid. A lack of response resulting in loss of Medicaid coverage, or a request for withdrawal from Medicaid, are not acceptable substitutes for a denial of coverage.
  • If you are eligible for Medicaid and have lost it, you will need to reapply for Medicaid coverage. Case Managers and Certified Application Counselors can help with reapplication and completing applications correctly. You can also call the medication access hotline (1-855-362-0658) for additional information.

VDH is getting various insurance documents by fax that are hard to read and/or have no contact information listed from the sender. When faxing enrollment worksheets, billing statements, or insurance card copies, please do the following:

  • Include the name and telephone number of the person faxing documents just in case there are questions.
  • Ensure you scan the entire document and not cut any of it off.
  • Include information on the cover page if your fax machine produces poor quality documents.

The Medication Hotline is getting a large volume of calls, but your calls are important to us.  Please leave a message and include your name, contact number, and reason for the call.  Please allow for one business day for returned calls before calling again.

Inform VDH if there is a change in client information (Name, Address, Phone number, Income, etc.). Most VDH communication is by mail or phone and it is important client information is current and that we know information that may affect services from the program.


Client Letters on Open Enrollment

  • If you are a client that receives medication through insurance that VDH pays for, please read this letter (en español).
  • If you are a client that receives medication through a local health department or other approved VDH site, please read this letter (en español).

Open Enrollment Updates

Calls are held weekly for those assisting with open enrollment to ask questions.  Notes from weekly calls are posted below for reference.


December 28, 2018

The below information applies to CIGNA Health Plans only:

January premium payments will not be posted by January 1, 2019 for clients enrolled with Cigna.  The delays are being addressed by Cigna and the carrier notified VDH that all client accounts on the payment lists submitted to Cigna (i.e., enrollments received & approved by December 21) will be placed in a hold status to prevent termination of the coverage.  Clients that are new enrollees with Cigna for 2019 will not be able to use their coverage until these issues are resolved.  Some clients that re-enrolled with Cigna for 2019 may also experience access issues.

Based on the information provided by Cigna, January payments should be posted by January 15, 2019.  If an affected client needs medication before this date, please contact the medication hotline at 855-362-0658.  VDH will process a 30-day temporary approval for those clients to access medications through a local health department or other medication pick-up site.  VDH and Benalytics will also be conducting courtesy calls to clients to share this information.

November 21, 2018

2019 Open Enrollment period started November 1 and ends December 15.  For this year's enrollment, the ACA module in e2VA will not be used to collect insurance enrollment on clients.  The 2019 Insurance Enrollment Worksheet should be completed for each client enrollment.  This is a computer-friendly Word document that information can be entered directly into or it can be printed and filled in manually.  This is same form used during the prior open enrollment period with only three additional elements: household income, family size, and a Medicaid-eligibility question.  If possible, please send the following information with the enrollment worksheet:

  • proof of income
  • proof of residency in Virginia
  • copy of insurance premium data from the Marketplace application

If the enrollment site is a VDH contracted service provider and you have an SFTP (secured) invoice folder (not your SFTP data folder), you may submit documents to the folder.  For all others, please fax the documents to 804-864-8050.

In prior years, some enrollment sites recorded each insurance enrollment on an Insurance Enrollment Tracking Log.  Sites provide these logs to VDH on a weekly basis to confirm receipt of enrollments submitted.  You can still send these logs to VDH this year.

Remember, if clients had Marketplace insurance last year or even insurance through their employers, they might qualify for Virginia Medicaid’s new low to no-cost insurance that will cover medicines, doctor and lab visits, and other services.  Benalytics can help clients find out which insurance they can get and help enroll them.  Client should call Benalytics at 855-483-4647.

Contact the Medication Access Hotline with any questions about open enrollment at 1-855-362-0658.


Virginia Department of Health (VDH) Supported ACA Marketplace Insurance Plans for 2019