Purpose, Background & Population Served

Purpose

The New York State Department of Health AIDS Institute has established five programs for Uninsured Care (ADAP, ADAP Plus, the HIV Home Care Program, ADAP Plus Insurance Continuation Program and the Pre-Exposure Prophylaxis Assistance Program). The mission of these programs is to provide access to medical services and care for all New York State residents with or at risk of acquiring HIV. The programs employ a dual approach to carry out their mission. First, the programs empower the individual to seek and access care by providing an "Enrollment Card", which allows the individual to choose a provider and receive care/drugs without cost. Second, the programs supply a stable and timely funding stream to health care providers, enabling them to use the revenues to develop program capacity to meet the needs of uninsured and underinsured HIV and HIV at risk populations.

Background

The AIDS Drug Assistance Program (ADAP) began in 1987 as part of a national program to provide free HIV/AIDS drugs to low-income individuals not covered by Medicaid or adequate third-party insurance. In November 1991, the HIV Home Care Program, modeled on ADAP, was implemented. In October 1992, ADAP Plus began operations. In July 2000, the ADAP Plus Insurance Continuation Program was implemented. In January 2015 the PrEP-AP began to provide access to primary care services and monitoring to support the use of Pre-Exposure Prophylaxis (PrEP) to prevent HIV infection. All programs are centrally administered, use a unified application form and coordinate outreach activities.

Population Served

The programs serve New York State residents who are HIV-infected or at risk of acquiring HIV infection and are uninsured or under-insured and meet established criteria. The programs can serve as a transition to Medicaid by providing interim assistance to persons eligible for but not yet enrolled in Medicaid, or assist in meeting spenddown requirements. Individuals with health insurance who cannot meet the deductibles or co-payments may enroll and programs will coordinate benefits with their insurance company. Adolescents who do not have access to the financial or insurance resources of their parents/guardians are eligible for the program.

Providers

ADAP has enrolled over 4,100 local pharmacies statewide. Any pharmacy enrolled in the New York State Department of Health, Elderly Pharmaceutical Insurance Coverage Program (EPIC) and Medicaid is eligible to join the ADAP pharmacy network.

ADAP Plus and PrEP-AP have enrolled 200 Article 28 health care providers. these providers are hospitals, clinics and rug treatment programs who have been approved for participation in the Medicaid Program. A total of over 200 physicians have enrolled. Eligible physicians must be enrolled in the Medicaid Program. Over 50 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 Home Health Agencies, Long Term 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.