- are HIV infected;
- are a resident of California;
- are 18 years of age or older;
- have a Modified Adjusted Gross Income that does not exceed 500% Federal Poverty Level based on family size and household income; and
- are not fully covered by or eligible for Medi-Cal or any other third-party payer.
Clients have two options:
1. Contact an ADAP enrollment worker. An enrollment worker can help clients with:
- Faxing the required supporting documentation to ADAP, and
- Indicating in the ADAP Enrollment System that the client would like health insurance premium assistance.
Please use the ADAP Enrollment Site List (Excel) to find a local ADAP certified enrollment site.
2. Enroll directly with OA. If clients cannot reach an enrollment worker or would prefer to enroll directly with OA, they can:
- Complete sections 1 (Profile) and 6 (Insurance) of the ADAP application (PDF)
- Sign and date page 9 of the application
- Sign and date the ADAP Consent Form (pages 10-11)
- Submit the completed ADAP application sections and health plan billing statement or California Enrollment Summary to ADAP.
Clients can submit completed forms with original signatures and documentation directly to OA using the following methods:
- Fax: (844) 421-8008 using the ADAP Fax Coversheet (PDF)
- Mail: Insurance Assistance Section, California Department of Public Health, P.O. Box 997426, MS 7704, Sacramento, CA 95899-7426
If clients or enrollment workers are having difficulty accessing enrollment materials or need additional assistance, they should contact the ADAP call center (844) 421–7050.
State covers some form of HCV drug therapies as part of their approved drug formularies: Yes
To learn more about what HCV drug therapies are on the drug formulary, please visit tiicann.org/co-infection-watch.html (go to page #7).