Chapter Listing

HIV/AIDS Related Health Benefits

Overview

Uninsured Care Programs

The New York State uninsured care programs include:

  • AIDS Drug Assistance Program (ADAP): pays for medication for the treatment of HIV/AIDS and opportunistic infections.
  • ADAP Plus: Pays for primary care services at select clinics, hospital outpatient departments, office-based physicians, and lab vendors.
  • HIV Home Care Program: Pays for up to $30,000 worth of home care coverage in the client’s lifetime for HIV-positive New Yorkers.
  • ADAP Plus Insurance Continuation Program (APIC): Pays for monthly premiums for, employer-provided insurance, COBRA coverage, commercial coverage purchased through the New York State of Health (the insurance marketplace), directly from an insurance company or agent, Medicare Part D, Medicare Advantage and Medicare Supplemental coverage.
  • Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) serve New York State residents who are HIV-infected or at risk of acquiring HIV infection and are uninsured or under-insured and meet eligibility criteria.

The uninsured care 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 eligibility criteria. For HIV home care program, an individual must show chronic medical dependency due to physical or cognitive impairment from HIV infection.

The Uninsured Care Programs are administered by The NYS Department of Health State AIDS Institute administers the program. There is no local administration.

AIDS Health Insurance Program (AHIP)

Although not part of the “Uninsured Care Programs” the AIDS Health Insurance Program (AHIP), established in 1991, assists persons with AIDS or HIV-related disease maintain their health insurance coverage after loss or reduction of employment.

AHIP pays for an eligible individual’s health insurance premiums.
The administration for the AHIP program is different. AHIP in New York City, is administered by the Human Resources Administration (HRA) through its Medicaid program. On the state level it is administered by the NYS Department of Health.

UNINSURED CARE PROGRAMS

The uninsured care 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 eligibility criteria. For HIV home care program, an individual must show chronic medical dependency due to physical or cognitive impairment from HIV infection. There are no copayments or deductibles with these programs.

There are no citizenship/ immigration criteria for these programs. Applicants must be residents of New York State and have income below 500% of the Federal Poverty Level (FPL).

The Application for the Uninsured Care Programs (DOH-2794) is used to enroll in ADAP, ADAP Plus, the HIV Home Care Program and PrEP-AP.

A different application is required for APIC (DOH-2794C). 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 all programs, however for the PrEP-AP a medical practitioner is required to verify that the applicant is HIV-negative. In addition, a treatment plan by a physician must also be submitted for Home Care applicants.

AIDS Health Insurance Program (AHIP)

Individuals must have AIDS or an HIV-related disease, as determined by the AIDS Institute of the New York State Department of Health, meet the citizenship/immigrant requirements of the Medicaid program, be residents of New York State, have some form of health insurance in place at the time they apply for AHIP and be eligible to continue their group health insurance coverage or convert it to a private plan. Households must have gross income below 185% of the federal poverty level. There is no resource test for AHIP.

Applicants should fill out a regular Medicaid application, DOH-4220, write AHIP on top of the application, and submit it to the local Medicaid center.

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