- Verifiable HIV/AIDS diagnosis. (Current CD4 and Viral Load lab documentation is required for Ryan White reporting)
- Verifiable low income status defined as a total household income that does not exceed 300% of current Federal Poverty Level guidelines.
- Verifiable uninsured or underinsured status.
- Individuals who are Medicaid-eligible or who have private health insurance coverage will not qualify for the ADAP program presently without verifiable documentation that HIV/AIDS medications are not covered by the insurance plan (e.g., letter received from the insurance carrier).
- Determination of eligibility and enrollment in other third party insurance programs including Medicaid and Medicare.
- Medicare eligible individuals must apply for a Medicare Part D prescription drug plan if person has been determined to be disabled for more than two years.
- Individuals who qualify for Medicare Part D prescription drug coverage must apply for that coverage. Providers can apply for assistance with Medicare Part D deductibles and/or co-pays. Providers can also apply for assistance with TROOP when recipients reach the Medicare Part D “coverage gap” if the individual meets other requirements for ADAP assistance.
- Individuals will not receive ADAP Program support if there is evidence of adequate insurance coverage for prescribed HIV/AIDS medications.
- Contact the MSDH ADAP Program for an application which includes a checklist of required forms (referred to below). Contact information is located on the patient eligibility sheet.
- The Medical Provider’s office is responsible for completing and signing the application (which includes MSDH Ryan White Services form (#256) and patient information form).
- MSDH Ryan White Services form (#256) is valid for six (6) months from the date signed by the medical provider unless there is a change.
- Form 256 also serves as the original written prescriptions for the pharmacy as well as the doctor’s order giving nurses in the Health Departments rights to issue medications to individuals. The ADAP Program must receive new prescriptions from the attending physician’s office upon request from the MSDH HIV pharmacist.
- If an ADAP enrollment “wait list” occurs due to the high volume of individuals requesting assistance, the medical provider will need to complete the MSDH Ryan White Services referral for services form (#256) only. On that form under “Lab/Test Results”, the medical provider must indicate the patient’s current CD4 + T-Lymphocyte cell count and list the patient’s current medication regimen.
- The applicant is responsible for completing and signing the financial status form along with providing current verification of income (within a month of the application date). If the applicant is available to complete the financial status form at the time the medical office prepares the application, the medical provider may contact the ADAP Program to provide the applicant with the required forms by mail. No applicant can be considered for support without submitting a completed Financial Status Form and providing current verification of income.
- Applications should be mailed to:
Attn: Carolyn Anderson, ADAP Branch Director
P. O. Box 1700
Jackson, MS 39215-1700 Once eligibility has been determined, the ADAP Office will mail notification of approval to the patient. This notification will also list the medications covered and the designated Health Department pick-up site.
NOTE: An approved ADAP application is also approval for dental services under Ryan White Part B if the individual does not have insurance for this purpose. Ryan White is the payor of last resort.