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ADAP - Eligibility, Enrollment Process and Provider Information

Eligibility Criteria

  1. Medical: HIV-infection (asymptomatics are eligible.)
  2. Residency: New York State (U.S. citizenship is not required.)
  3. Financial: Financial eligibility is based on 435% of the Federal Poverty Level (FPL). FPL varies based on household size and is updated annually. Financial eligibility is calculated on the gross income available to the household, excluding Medicare and Social Security withholding and the cost of health care coverage paid by the applicant. Households cannot have liquid assets greater than $25,000. Liquid assets are cash, savings, stocks, bonds, etc. Liquid assets do not include car, home or federally recognized retirement accounts.
  4. Home Care: AIDS or HIV illness and chronic medical dependency due to physical or cognitive impairment from HIV infection.

Enrollment Process

A single application form can be used to enroll in ADAP, ADAP Plus and the HIV Home Care Program. An additional application is required for APIC. Applicants apply to the program, providing proof of residency, income and assets. A Medical Application signed by a licensed medical professional is required, verifying HIV-infection and indicating the applicant's medical status. A treatment plan by a physician must also be submitted for Home Care applicants. Enrollment in the Programs is coordinated for all eligible individuals. Upon determination of eligibility, an Enrollment Card is issued which may be used to receive care from an enrolled provider. The programs provide an automated eligibility verification system to allow providers to confirm participant eligibility status.

Providers

ADAP has enrolled over 3,100 local pharmacies statewide. Any pharmacy enrolled in the New York State Department of Health Elderly Pharmaceutical Insurance Coverage Program (EPIC) is eligible to join the ADAP pharmacy network.

ADAP plus has enrolled over 165 Article 28 health care providers (over 280 service sites). These providers are hospitals, clinics and drug treatment programs who have been approved for the HIV Primary Care Medicaid Program. All facilities provide a full range of HIV primary care services. In December of 1993, ADAP Plus began enrollment of private physicians. A total of over 425 physicians have enrolled. Eligible physicians must be enrolled in the Medicaid HIV Enhanced Fees for Physicians (EFP) Program. Over 60 laboratories are also enrolled to provide laboratory and ancillary services. Laboratories must be certified by the New York State Department of Health and participate in Medicaid.

The HIV Home Care Program has provider agreements with over 50 Home Health Agencies, Long Term Home Health Care Programs, Hospices and Licensed Home Care Services Agencies. Home Care agencies are screened through the New York State Department of Health Bureau of Long Term Care.