General Overview and Eligibility
The AIDS Drug Assistance Program (ADAP) provides FDA approved HIV-related prescription drugs to underinsured and uninsured individuals living with HIV/AIDS. In the State of Alaska, to be eligible for ADAP enrollment, an individual must meet the following criteria:
- a. Documented HIV positive status
- b. Residency in the State of Alaska
- Residing in Alaska for a minimum of 30 days
- Willing to sign an "intent to Stay" letter
- c. Income eligibility
- Income less than or equal to 400% of the Federal Poverty Level of Alaska for the applicable family size
- Non-income assets that fall within the level allowed for Medicaid eligibility
- d. Be prescribed a medication on the ADAP formulary by an Alaska physician
- e. Be an active client of one of the State-funded HIV Care Consortium lead agencies. Currently, these agencies include the Alaskan AIDS Assistance Association (Four A's) and the Interior AIDS Association (IAA).
The ADAP is required by federal law to be the "payer of last resort." The ADAP may not provide to an individual who is eligible for Medicaid or other Public Assistance, or who has private insurance or Veterans Administration benefits, any benefits that could be covered by the non-ADAP payer.
An individual enrolled in the ADAP must provide the Four A's ADAP coordinator the information and documentation necessary to determine financial eligibility for the ADAP on an annual basis in order to remain enrolled (annual recertification). The Four A's may request updated documentation of financial eligibility at any time there is indication that information currently on file has changed.
An individual may self-refer to the ADAP (and become a client) at the Four A's or be referred to the ADAP by another agency. ADAP eligibility must be determined by a representative of the contract administrative agency (the Four A's). To be considered, each applicant must complete:
- An "ADAP Intake" form
- A Four A's (as administrative entity) "Release of Information" form
- Income verification for 3 recent months or the current tax return
All applications are reviewed and eligibility is determined by the Four A's ADAP coordinator.
Funding for the ADAP program is limited and there is potential for a waitlist to be established. A waiting list for ADAP enrollment will be established when the costs projected to maintain those persons currently enrolled approximate the amount of ADAP funds available (as budgeted). If a waitlist is established, the following criteria will be used to selected individuals from the waitlist when an opening develops in the program:
1. When the ADAP is fully enrolled, the ADAP coordinator will notify medical providers treating current ADAP and Title II lead agency (the Four A's and IAA) clients that patients wishing to newly enroll in ADAP will be placed on a waiting list until space becomes available for them. As much advance notice as possible will be provided so that persons needing medication support can be assisted to access other sources of funding in a timely manner.
2. Persons will be enrolled in the ADAP from the waiting list as ADAP funds sufficient to cover the year's projected expenditures become available. Persons will be enrolled from the waiting list in such a way that the geographic distribution of persons enrolled in ADAP approximates the geographic distribution of estimated living HIV/AIDS cases in Alaska. When there are eligible individuals on the waiting list from under-represented economic regions of the state, available "slots" will be filled from those areas first until the geographic representation of persons on the ADAP approximates that of estimated living HIV/AIDS cases in the state.
3. When all geographic areas are proportionately represented or when there are no waitlisted individuals from under-represented regions, the individual at the top of the waiting list will be the next to be enrolled in ADAP.
4. Wait-listed individuals may call the ADAP coordinator to obtain updates on their status.
Affordable Care Act (ACA) or Alaska Comprehensive Health Insurance Association (ACHIA)
All persons enrolled in ADAP are evaluated for inclusion through the Affordable Care Act (ACA) or Alaska Comprehensive Health Insurance Association (ACHIA). If you meet ACA criteria, you will be assisted in enrolling in the ACA during periods of open enrollment or special enrollment periods. Special enrollment periods occur within 60 days of a qualifying life event such as: a job loss, death of a spouse, birth of a child, became a new resident of the state, released from incarceration, etc. All persons enrolling in the ACA will be covered by a plan that best meets their health care needs and offers the premium tax credit.
Those individuals whose are enrolled in COBRA through thru their former employers and whose benefits will end before open enrollment for the ACA will be considered for ACHIA as a stop-gap measure.
All persons enrolling in ACA must use their Advanced Premium Tax Credit (APTC) to assist ADAP in getting the most cost-effective rate. If an ADAP client is eligible for a premium tax credit when applying for federal Market Place Insurance, the client must request the tax credit at the time of application.