To be eligible for the AIDS Drug Assistance Program (ADAP) in Minnesota, a person must:
- Be HIV positive
- Be uninsured or insured with a drug co-pay
- Have income below 400 percent of the Federal Poverty Guidelines.
You cannot be on Medical Assistance, Medical Assistance for Employed Persons with Disabilities or MinnesotaCare.
- Read the Notice of Privacy Practices and Rights and Responsibilities on pages B through D at the back of the form. Tear them off and keep them.
- Answer all questions on the application. If you need more space, write the number of the question and the answer on a separate piece of paper. Include it with the application.
- Sign and date the application.
- Attach proofs. Proofs are listed on page A.
Mail the completed application to:HIV/AIDS Programs
P.O. Box 64972
St. Paul, MN 55164-0972