Summary

An applicant for ADAP, ADAP Plus and APIC must have an HIV-infection, including those who are asymptomatic. For home care services, an individual must show an AIDS diagnosis or an HIV illness and chronic medical dependency due to physical or cognitive impairment from HIV infection. An applicant for PrEP-AP must be HIV-negative at high risk of infection.

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

While individuals enrolled in Medicaid or other comprehensive health insurance are not eligible, individuals who have Medicaid with a spenddown would be able to use any co-payments the program charges to meet their spenddown amount.

Persons Included in the Applying Household

WHO IS INCLUDED IN THE HOUSEHOLD – HOUSEHOLD FILING UNIT

• Parents, stepparents and their children under 21 living together

• Spouses living together

• For ADAP applicants: Anyone supported by the ADAP recipient and claimed as a dependent on their income tax return should be include in the household size.

PERSONS NOT INCLUDED IN THE HOUSEHOLD

• Applying related children (niece/nephew, cousin, grandchildren)

• Children 21 and over

• Caretaker related by blood, for example grandparents, adult siblings, aunts or uncles

Medical Criteria

ADAP, ADAP PLUS, APIC

An applicant must have an HIV-infection and includes those who are asymptomatic.

HIV HOME CARE

An applicant must show an AIDS diagnosis or an HIV illness and chronic medical dependency due to physical or cognitive impairment from HIV infection.

PREP-AP

An applicant must have a documented negative HIV test result and be at risk of acquiring HIV infection.

Citizenship/Immigration Status

There are no citizenship/immigration criteria for the Uninsured Care Programs (ADAP, ADAP Plus, the HIV home care program, APIC and PrEP-AP). Undocumented immigrants can receive these programs, if otherwise eligible.

Residency

Applicants must be residents of NYS. There is no durational requirement for residency in NYS. Applicants must apply in county of residency.

Access to Other Health Insurance

ADAP, ADAP PLUS, HIV HOME CARE, PREP-AP

Uninsured care programs for HIV/AIDS cannot provide help to anyone who has the total cost of services or medication reimbursed by another health insurance plan. This includes Medicaid and Medicare, and Medicare Part D. However, these programs can help to meet deductibles, co-payments and/or other out-of-pocket expenses for people who have partial coverage or in a waiting period. See above, Description of Uninsured Care Programs for HIV/AIDS, Coordination of Benefits.

At application and periodically thereafter, the programs will seek to identify individuals who are potentially eligible for Medicaid and encourage them to apply. Medicaid is the preferred medical coverage for individuals who meet their eligibility requirements, because of Medicaid’s broader range of covered services.

APIC – EVALUATION OF INDIVIDUAL’S HEALTH PLAN’S COST EFFECTIVENESS

An individual’s health insurance plan will be evaluated for the following criteria:

• Cost effectiveness – will the insurance cost less than APIC coverage?

• Quality of coverage – will the insurance pay for HIV specialists, drug and medical care?

• Employer health plan – if the individual has access to health insurance offered by his/her employer is the cost of the individual’s insurance premium too high for his/her income? For questions about this, call the UCP Hotline 800-542-2437 or 844-682-4058.

Assets/Resources

The New York State Department of Health eliminated the resource requirement in April 2019.

Income

Income must fall below 500% of the Federal Poverty Level (FPL). The cost of the following premiums is deducted when calculating an applicant’s gross income:

• FICA & Medicare deductions from salary

• Medicare Part B premiums

• Medicare Part D premiums

• Other third-party health insurance premiums