Summary
A single application form can be used to enroll in ADAP, ADAP Plus, the HIV Home Care Program and PrEP-AP.
A different application is required for APIC.
In addition, a separate medical application, signed by a licensed medical professional verifying HIV-infection and indicating the applicant’s medical status, must also be submitted for ADAP, ADAP Plus, HIV Home Care Program, and APIC. Medical verification that an individual is HIV-negative, but at risk of HIV infection is required for PrEP-AP. In addition, a treatment plan by a physician must also be submitted for applicants of the HIV Home Care program.
The application procedures for the Uninsured Care Programs have not changed with the implementation of the Affordable Care Act.
Applicants’ Rights and Responsibilities
RIGHT TO APPLY
Any person has the right to apply for any of the uninsured programs and to receive a written notice of acceptance/denial. Applicants who are denied the right to apply should speak to a supervisor and insist on the right to apply and the right to receive a written denial.
RIGHT TO INTERPRETERS FOR NON-ENGLISH SPEAKING APPLICANTS
Under no circumstance can someone be denied service due to his/her inability to communicate in English.
COMPLAINTS AGAINST DISCRIMINATION
Public Law 88-352, the Civil Rights Act of 1964 as amended in 1972 , Section 601 and Rehabilitation Act of 1973 protects an applicant from discrimination based on race, color, national origin, age, sex, religion, handicap from being excluded from participation in and application for the Uninsured Care Programs. Individuals who believe they have been denied on any of these bases should contact:
Linda Colon, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
Jacob Javits Federal Building
26 Federal Plaza – Suite 3312
New York, NY 10278
Telephone: 212-264-3313
Fax: 212-264-3039
TDD: 212-264-2355
RIGHT TO APPEAL
There is no formal appeals process for the Uninsured Care Programs. If a recipient has a complaint about denial of coverage, processing or another matter they can write a letter to Uninsured Care Programs and a representative will handle their claim. Issues are resolved on a case-by-case basis. There are no time frames in which complaints must be resolved.
Applying for the Uninsured Care Programs for HIV/AIDS
OBTAINING THE APPLICATION
The Application for the Uninsured Care Programs (DOH-2794) can be used to enroll in ADAP, ADAP Plus, HIV Home Care Program and PrEP-AP. The application and instructions are found at https://www.health.ny.gov/forms/doh-2794.pdf.
APIC: A different application is required, which is found at: https://www.health.ny.gov/diseases/aids/general/resources/adap/docs/apiceng.pdf.
A separate medical form, DOH-3608, found at https://www.health.ny.gov/forms/doh-3608.pdf by a licensed medical professional verifying HIV-infection and indicating the applicant’s medical status, must be also be submitted for all uninsured care programs.
o PrEP applicants must have a documented negative HIV test result and be at risk of acquiring HIV infection.
In addition, a treatment plan by a physician must also be submitted for Home Care applicants. Use the DOH-3068 above.
SUBMITTING THE APPLICATION
For ADAP, ADAP Plus, HIV Home Care Program, PrEP-Assistance Program (PREP AP) applications can be completed by mail, by fax or online. Applicants can call 800-542-2437 for help or with questions. Out of State call 518-459-1641.
By Mail
Completed applications with required documentation can be mailed to:
New York State Department of Health
Uninsured Care Programs
Empire Station
P.O. Box 2052
Albany, NY 12220-0052
By fax
Fax completed application and supporting documentation to UCP at 518-459-2749 or 518-453-0522
Online
An application can be completed and submitted online at
https://www.health.ny.gov/diseases/aids/general/resources/adap
Immediately after submitting the application, the applicant (and case manager or social worker) should call the ADAP office in Albany (800-542-2437 or 844-682-4058).
APIC
AHIP pays for current health insurance premiums; therefore, applicants must have insurance in place at time of application. If the insurance coverage is scheduled to end, individuals must apply before the scheduled end date. AHIP cannot replace the insurance or purchase new insurance.
If an individual loses health insurance, they can apply for ADAP/ADAP Plus to immediately help pay for medications and outpatient care, then call UCP to be referred to a case manager or navigator for help enrolling in new coverage and applying for APIC to pay for it.
Medicaid Recipients
As mentioned above, applicants who have full, active, New York State Medicaid are not eligible for UCP programs. However, if the individual was notified that their Medicaid will be ending shortly, this should be clearly stated with the application.
This information can also be shared by calling the ADAP hotline. A UCP staff can help coordinate coverage at the start of ADAP/ADAP Plus with the end of the Medicaid coverage.
If the client has Medicaid with a Spenddown, a copy of their spend-down letter should accompany the application, and the spend-down amount should be clearly stated on the ADAP application.
HIV HOME CARE PROGRAM
An HIV Home Care application should only be submitted when there is a medical necessity. HIV Home Care applications receive immediate processing because the applicants need immediate home care service.
Advocates working with individuals who need home care should call UCP (800-542-2437) to alert HIV Home Care staff that a home care application was submitted. UCP staff will need to know which enrolled HIV Home Care Provider will be staffing the case. USP staff will contact the provider staff to get the home care documentation.
The HIV Home Care program does not reimburse retroactively for home care. Services cannot be reimbursed if the proper paperwork has not been received.
The Department of Health has published a video “How to Submit Documents Online for the Uninsured Care Programs”, go to https://www.health.ny.gov/diseases/aids/general/resources/adap
Processing Time
TIME FRAMES
To promote rapid access to antiretroviral therapy, the UCP’s enrollment process facilitates same-day enrollment. The recipient will receive an eligibility card with their participant identification number and instructions on how to use it, the UCP Covered Services Formulary, and the UCP Welcome letter.
PREP-AP
PrEP-AP applications can only be approved when all documents are received. It normally takes 7-10 business days to process a PrEP-AP application. Once the application is approved, the applicant will receive an active PrEP-AP number. A PrEP-AP card and welcome packet will be sent by mail.
If the applicant has received PrEP-AP covered medical services from an enrolled PrEP-AP provider in the 30 days prior to receiving an active PrEP-AP number, PrEP-AP can retroactively pay for those services. Since medications are not a covered service under the PrEP-AP program, there is no retroactive coverage for PrEP medications.
APIC
A properly completed APIC application with all the needed supporting documentation can be processed in 2 weeks. APIC does not offer retroactive coverage.
Special Populations
YOUTH
Adolescents or people living with their parents who do not have access to their parents’ financial or insurance resources may be eligible for these programs. This may be the case if they do not want their parents to know about their condition. Although they must establish residency, they have the option to receive correspondence at another mailing address.
CRIMINAL JUSTICE INVOLVED
Individuals released from a New York State or Federal correctional facility and does not have active New York State Medicaid, they are eligible for ADAP/ADAP Plus.
If they were recently discharged (within 30 days), a completed ADAP/ADAP Plus application can be submitted, with a completed Medical application and a copy of their prison discharge paperwork, showing where they will be living upon discharge. If the applicant returned to the community more than 30 days ago, their address and income may have changed, so the regular proof of income and address must be sent with the application.