DB101 California - AIDS Drug Assistance Program (ADAP): Frequently Asked Questions

Disability Benefits 101: working with a disability in California

Printer-Friendly

E-Mail This Page to a Friend

1) What is the AIDS Drug Assistance Program (ADAP)?

2) Is ADAP the same in all states and Commonwealths?

4) What does ADAP provide and how long will it last?

5) What are the medical eligibility requirements for ADAP?

6) Does what I have in the bank and/or what I own, such as a home or car, affect my eligibility for ADAP?

7) How do I prepare to apply for this benefit?

9) What other benefit programs are available to me and how do they work with ADAP?

10) How do I stay enrolled/eligible in ADAP? How often do I have to reapply?

11) What happens when I work while receiving benefits from ADAP?

12) What happens if I don't have all of the required documentation when I apply for ADAP?

13) Can I use ADAP to meet my Medi-Cal share-of-cost?

14) Will ADAP pay my County Medi-Cal Services Program (CMSP) share-of-cost?

1) What is the AIDS Drug Assistance Program (ADAP)?
If you qualify, ADAP may pay for some or all of the cost of HIV/AIDS related medications that other insurance does not cover.

2) Is ADAP the same in all states and Commonwealths?
No. Although ADAP is available in all 50 states and Commonwealths, it is not the same everywhere. Each state or Commonwealth is responsible for: Establishing ADAP eligibility; Determining the type, amount, duration and scope of services; Developing a list of covered prescriptions on its formulary; and Administering the Program.

3) Who is eligible for ADAP?
To be eligible for ADAP you must: Be a California resident; Be at least 18 years of age; Have an HIV/AIDS diagnosis; Have a valid prescription from a California licensed physician; Have a Federal Adjusted Gross Income that does not exceed $50,000; and Have limited prescription drug coverage.

4) What does ADAP provide and how long will it last?
ADAP covers some or all of the cost associated with medications commonly used to treat HIV/AIDS and related complications. ADAP benefits will last as long as you meet the eligibility and annual recertification requirements.

5) What are the medical eligibility requirements for ADAP?
You must have an HIV or AIDS diagnosis.

6) Does what I have in the bank and/or what I own, such as a home or car, affect my eligibility for ADAP?
No. What you have in the bank and what you own does not affect your ADAP eligibility. ADAP uses your Federal Adjusted Gross Income to determine financial eligibility. This income must be under $50,000 per year.

7) How do I prepare to apply for this benefit?

You will need the following documents to complete your ADAP application:

Proof of California residence (e.g. rental agreement or utility bill).
Picture identification (California Drivers License, California Identification card, Passport, School I.D., etc.)
Proof of income (Federal or State Income Tax returns with corresponding W2 or 1099 forms, pay stubs, Public Assistance or Social Security Award Letters).
Proof of Medi-Cal application (if applicable) and/or documentation of any current health coverage (if applicable).
Letter of HIV diagnosis including CD4 count and viral load from a physician.

8) How do I apply for ADAP?
To apply for the AIDS Drug Assistance Program you need to contact your local county enrollment office using the site locator.

9) What other benefit programs are available to me and how do they work with ADAP?

In general, ADAP is the payer of last resort. If you are eligible for private health coverage with prescription benefits, ADAP will require you to use those benefits first before paying any copayments, coinsurance, or deductibles. ADAP can also pay for drugs that aren't covered under the insurance plan.

If you are considered to be potentially eligible for Medi-Cal, ADAP will require you to apply for such coverage. If you are eligible for free Medi-Cal, you cannot get ADAP. If you are eligible for Medically Needy Medi-Cal with a Share of Cost, costs that ADAP covers can go towards your share of cost. If you are eligible for other types of Medi-Cal, Medi-Cal will pay first and ADAP second.

If you have Medicare the California Office of AIDS has this FAQ to help you learn how the programs interact.

10) How do I stay enrolled/eligible in ADAP? How often do I have to reapply?
To be eligible for ADAP you must continue to meet the financial eligibility requirements for the program. In addition, ADAP requires you to recertify annually.

11) What happens when I work while receiving benefits from ADAP?
If you continue to meet the financial eligibility requirements for ADAP and recertify annually, working will not affect your benefits from this program. If your income increases above 400% of the Federal Poverty level, but stays below $50,000, you will continue to be eligible for ADAP but will have a copayment.

12) What happens if I don't have all of the required documentation when I apply for ADAP?
If you do not have all the required documentation for your ADAP application, you may qualify for temporary (30-day) access to prescription benefits. However, you must submit any missing documentation within 30 days of the application date to continue receiving benefits.

13) Can I use ADAP to meet my Medi-Cal share-of-cost?
It depends. If you have Medi-Cal without Medicare, drugs that ADAP pays for can help meet your share of cost. If you have Medi-Cal and do have Medicare, ADAP will not meet your share-of-cost.

14) Will ADAP pay my County Medi-Cal Services Program (CMSP) share-of-cost?
No. ADAP will only cover your County Medi-Cal Services Program for prescriptions on the ADAP formulary.

ADAP | PAPs | Next >>

. Disclaimers. Privacy.