Eligibility

1. All client eligibility for ADAP is determined at local health departments or through Virginia Commonwealth University Health Systems Financial Counseling and Governmental Services.

2. The client will need to provide written prescriptions for all requested medications. Documentation of CD4 and viral load counts are required for some medications.

3. The client must be ineligible for Medicaid. The Medicaid Referral Assessment form provides a means to screen ADAP clients to determine whether referral to Department of Social Services to submit a Medicaid application is indicated. If client is referred, verification of application submission must be provided within 14 days of entry into ADAP. To remain eligible for ADAP, clients must submit proof of Medicaid ineligibility within 90 days of Medicaid application. If client loses Medicaid coverage, medications will again be provided through ADAP.

4. The client cannot have health insurance coverage for the prescribed medications.

5. Annual family income cannot be greater than 300% of poverty level. For Northern Virginia, the limit is 333%. Clients need to provide proof of income when applying for ADAP and annually when eligibility is recertified. (Income chart).

6. A change in federal policy now gives Veterans (who meet all other ADAP eligibility criteria) the option of accessing covered medications through ADAP.

7. Persons incarcerated in jails or prisons may not utilize ADAP.

8. ADAP eligibility must be recertified every 12 months. Clients are required to report changes in income, insurance, or Medicaid status when they occur. Failure to report changes in factors impacting eligibility may result in discontinuation of ADAP services.

9. Medicare eligibility status must be documented at the time of initial and annual ADAP eligibility determination. Federal policy mandates that ADAP clients who are eligible for Medicare must enroll in the new Medicare Part D. benefit. While enrollment for Medicare Part D starts November 15, 2005, ADAP clients have until May 15th, 2006, to fulfill this requirement. Additional information about the impact of the Part D benefit on ADAP will be posted to the website as it becomes available.

Questions or comments? Contact HIV/STD/Viral Hepatitis Hotline