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Eligibility


 
Click here to download an application or call the toll-free number to complete an application over the phone.
1-855-362-0658 (phone) / 1-804-864-8050 (fax)

The Application Process | Enrollment | Recertification | Criteria | ADAP Service Options

 

The Application Process

  • There are two options to complete an application:
    • Clients may complete the entire application themselves and mail and/or fax to the ADAP Central Operations Office (Fax 1-804-864-8050, Toll Free Fax 1-877-837-2853, Mailing address: Virginia Department of Health, Eligibility, 1st Floor, 109 Governor Street, Room 326, Post Office Box 2448, Richmond, VA 23218). The application can be found on-line at: ADAP Forms and Brochures.
    • Clients may call the Medication Eligibility Hotline (1-855-362-0658), and staff will help with the application process. The application will be mailed to the client to sign and provide documents verifying income. The application can be returned to VDH in the postage-paid envelope that will be included.
  • Application Process: To enroll in ADAP clients must apply through VDH ADAP Central Office or through the Virginia Commonwealth University Health Systems (VCUHS) Financial Services (if clients receive services there). Applicants will be given thirty days (30) to respond to the first request for documents. A second request will be made after 30 days if the needed documents have not been received. Applicants who do not respond after sixty days (60) will be deemed non-responsive in providing the completed ADAP application process and would need to re-submit a complete application to be approved for ADAP.
  • The ADAP application is used to apply for all ADAP Service Options: Direct ADAP, the Medicare Part D Assistance Program (MPAP), the Health Insurance Marketplace Assistance Program (HIMAP) and the Insurance Continuation Assistance Program (ICAP).
  • When approved by the client, the ADAP Central Office staff will work with client advocates (case managers, local health department ADAP coordinators, social workers) to assist with and complete the application.

Enrollment

  • Once the client’s application is complete, the ADAP Central Office staff will determine the service that best meets the client’s needs. This could include Direct ADAP (medications provided to the client), the Medicare Part D Assistance Program (MPAP), or financial assistance with insurance costs through the Insurance Continuation Assistance Program (ICAP) or Health Insurance Marketplace Assistance Program (HIMAP).

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Recertification

  • Each client must complete a recertification every six months. The VDH ADAP Central Office staff will make every effort to ensure that Recertification occurs timely and successfully. Clients will have 45 days to submit this information and to sign, or attest to the information on the recertification forms. The application must be complete to maintain access to medications.

Criteria

Please view ADAP Updates for the most current policy information.

    Residency: ADAP applicants must live in Virginia.
    Required Medical Documents: CD4 count(s) and Viral Load(s) are needed at the time of the ADAP application and upon recertification. These lab values must be within the last six months.
    Insurance Coverage: Each applicant will be screened by the ADAP Central Office to see if they have health insurance that covers any medications. ADAP may be able to help with client cost shares (medication deductibles and copayments) under insurance. During open enrollment, if clients are ADAP eligible they will be screened to see if ADAP can provide assistance for insurance premiums and medication copayments for certain insurance plans under the Affordable Care Act’s federal Health Insurance Marketplace.
    Services to Veterans: Federal policy gives Veterans (who meet all other ADAP eligibility criteria) the option of receiving covered medications through ADAP.
    Medicaid: Clients must not qualify for or have Medicaid. If the client is referred to Medicaid, proof that the application was sent to the Department of Social Services (DSS) must be submitted within 14 days. ADAP Central Office will approve a completed ADAP application and provide medication through the Local Health Department (LHD) or other site pending a review of the Medicaid application. To remain eligible for ADAP services, clients must submit proof of Medicaid ineligibility within 90 days of submitting a Medicaid application. If a client loses their Medicaid coverage, ADAP can provide medication assistance.
    Income Criteria: Each ADAP applicant qualifies if their individual or family income is less than 400% of the Federal Poverty Level (FPL). If the individual or family income changes it is the duty of the client to advise the ADAP Central Office. Click here for information regarding Financial Eligibility Determination.
    ADAP Recertification: Clients must qualify every six months to continue to receive ADAP services. The ADAP Central Office will request by mail or phone any changes to income, insurance, or living arrangements.
    ADAP Services to Released Incarcerated Persons: Before or upon release from incarceration, the client will be referred to VDH Care Coordination by calling 1-804-864-7919. An ADAP application may be completed prior to release to help expedite enrollment; however, the application will not be approved until after the client is released. Upon release from a local/regional jail that is participating with the Expedited Enrollment Program (EEP), client should receive a 7-day supply of medications from the jail. Upon release from the Department of Corrections (DOC), client should receive a 30-day supply of medication from the DOC. Once released, a client ADAP application will be processed through the EEP within 48 hours. Clients will be enrolled to Direct ADAP or MPAP, depending on eligibility. During the ACA open enrollment period, all eligible clients will be referred for ACA insurance enrollment.
    Expedited Enrollment for Pregnant Women and Minors: Pregnant women and minors are prioritized to ensure access to medications and to prevent treatment interruption. Medical providers may contact ADAP at: 1-855-362-0658 to coordinate.
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ADAP Service Options

1. Direct ADAP: If a client does not have any other coverage for their HIV/AIDS medications (such as insurance or Medicare Part D), medications can be picked up at any Local Health Department (LHD) or at VCUHS, INOVA, or Carilion Health if they receive services at those sites.
  • Medication will be shipped from the VDH Central Pharmacy to LHD or alternate medication access site.
  • Direct ADAP clients receive a 30-day supply of medication at a time.
  • Clients may change their pick up site from one site to another by calling the VDH ADAP Central Office. VDH will send a letter noting the change. The letter will be sent to the client, medical provider, the old site, the new site, and pharmacy.
  • Only ADAP Formulary medications will be sent to the LHD or an alternate medication access site.
  • When picking up medications, the client or a designee may be asked by staff to show identification so medications are given to the correct client. Designees must have permission to pick up a client’s medications.
  • The ADAP Central Office staff communicates to LHD ADAP staff or alternate medication access site as needed about client enrollment, recertification, medication pick-up, labs, and data to ensure ongoing ADAP services.
  • VCUHS Financial Services will continue to oversee the initial ADAP eligibility for their clients picking up ADAP medications from alternate medication access sites (Ambulatory Care Center (ACC), Hayes E. Willis Clinic or other sites). Recertification at 6 months is handled by the ADAP Central Office.
2. Medicare Part D Assistance Program (MPAP): MPAP clients are helped with monthly premiums and cost shares. Cost shares are medication deductibles and medication copayments. VDH will assist with copayments for medications on the Medicare formulary. MPAP clients can pick up medications at any pharmacy that accepts their Medicare Part D plan and is within the Ramsell network.
    MPAP Policies
    • All ADAP applicants who have Medicare Part D coverage must enroll in MPAP.
    • Clients may enroll into Direct ADAP only while applying for a Medicare Part D plan.
    • ADAP clients with household incomes less than 150% of the FPL must apply for Low Income Subsidy (LIS).
    • Clients who qualify for full LIS are not eligible for MPAP. Those with partial LIS coverage or no LIS qualify for MPAP.
    • When approved for MPAP, the client, their provider and LHD or alternate medication access site will be sent a letter (or fax), and the client will no longer access medications through Direct ADAP.
3. Insurance Continuation Assistance Program (ICAP):
    Individuals with certain private insurance with medication benefits are eligible for ADAP assistance with their medication copayments and deductibles if all other qualifications are met. Each applicant must follow the ADAP enrollment and recertification processes noted above. This service allows ADAP to assist those with limited income access medications at a retail pharmacy. At any point in time a client loses insurance, the client can access medications through Direct ADAP if the client continues to meet ADAP eligibility criteria.

    This assistance is subject to certain restrictions depending on the type of insurance policy held by the client to ensure the maximum number clients can be served. Federal policy requires that ADAPs ensure that antiretrovirals offered on the ADAP Formulary are also offered on insurance plan formularies if ADAP dollars are being used. Medication copayment assistance will cover medications on the ADAP Formulary and the Ryan White Part B Non-ADAP Formulary. See the below for links to these two formularies.

    VA ADAP Formulary
    VA Ryan White Part B Formulary

4. Health Insurance Marketplace Assistance Program (HIMAP):
    ADAP plans to support costs for insurance premiums and medication cost shares for clients who enroll in VDH approved plans under the federal Insurance Marketplace under the Affordable Care Act. Please check the ADAP home page for approved plans.

Application Materials

APPLICATION PAPERWORK

Application:
Send this completed document to submit an application: English / Spanish
Provider's Statement :

This document is completed by the provider.

"No Income" Letter

"No Income" Letter-Spanish

1- 855-362-0658

Toll Free ADAP Hotline

1-804-864-8050

Toll Free 1-877-837-2853

ADAP Fax


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

Last Updated: 09-19-2014

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