To be eligible for assistance, an individual must meet the following criteria and furnish the following information to the Montana HIV Treatment Program:
- Have a permanent Montana address.
- Have written documentation of income less than 431% of the federal poverty level (adjusted gross taxable income).
- Be ineligible for any other assistance programs that would cover such costs.
- ADAP clients are required to re-verify income every six months or as requested by the program. Copies of MarketPlace insurance eligibility letters are required as appropriate.
Insurance plans/premiums and Cash Option payments will be evaluated for cost‐effectiveness before premium payment assistance is authorized.
Applicant must submit a completed HIV Treatment Program application, a recent tax return document or other income verification, and a completed medical verification form and which has been signed by an HIV case manager certifying that the client is HIV positive, and receiving care.
Mail or fax completed applications to:Rob Elkins, DPHHS
P.O Box 202951
Cogswell Bldg C‐211
Helena, MT 59620‐2951