Please view ADAP website for the most current policy information.
Residency: ADAP applicants must live in Virginia.
Required Medical Documents: CD4 count(s) and Viral Load(s) are needed at the time of the ADAP application and upon recertification. These lab values must be within the last six months.
Insurance Coverage: Each applicant will be screened by the ADAP Central Office to see if they have health insurance that covers any medications. ADAP may be able to help with client cost shares (medication deductibles and copayments) under insurance. During open enrollment, if clients are ADAP eligible they will be screened to see if ADAP can provide assistance for insurance premiums and medication copayments for certain insurance plans under the Affordable Care Act’s federal Health Insurance Marketplace.
Services to Veterans: Federal policy gives Veterans (who meet all other ADAP eligibility criteria) the option of receiving covered medications through ADAP.
Medicaid: Clients must not qualify for or have Medicaid. If the client is referred to Medicaid, proof that the application was sent to the Department of Social Services (DSS) must be submitted within 14 days. ADAP Central Office will approve a completed ADAP application and provide medication through the Local Health Department (LHD) or other site pending a review of the Medicaid application. To remain eligible for ADAP services, clients must submit proof of Medicaid ineligibility within 90 days of submitting a Medicaid application. If a client loses their Medicaid coverage, ADAP can provide medication assistance.
Income Criteria: Each ADAP applicant qualifies if their individual or family income is less than 400% of the Federal Poverty Level (FPL). If the individual or family income changes it is the duty of the client to advise the ADAP Central Office. Click here for information regarding Financial Eligibility Determination.
ADAP Recertification: Clients must qualify every six months to continue to receive ADAP services. The ADAP Central Office will request by mail or phone any changes to income, insurance, or living arrangements.
ADAP Services to Released Incarcerated Persons: Before or upon release from incarceration, the client will be referred to VDH Care Coordination by calling 1-804-864-7919. An ADAP application may be completed prior to release to help expedite enrollment; however, the application will not be approved until after the client is released. Upon release from a local/regional jail that is participating with the Expedited Enrollment Program (EEP), client should receive a 7-day supply of medications from the jail. Upon release from the Department of Corrections (DOC), client should receive a 30-day supply of medication from the DOC. Once released, a client ADAP application will be processed through the EEP within 48 hours. Clients will be enrolled to Direct ADAP or MPAP, depending on eligibility. During the ACA open enrollment period, all eligible clients will be referred for ACA insurance enrollment.
Expedited Enrollment for Pregnant Women and Minors: Pregnant women and minors are prioritized to ensure access to medications and to prevent treatment interruption. Medical providers may contact ADAP at: 1-855-362-0658 to coordinate.
- There are two options to complete an application:
- Clients may complete the entire application themselves and mail and/or fax to the ADAP Central Operations Office (Fax 1-804-864-8050, Toll Free Fax 1-877-837-2853, Mailing address: Virginia Department of Health, Eligibility, 1st Floor, 109 Governor Street, Room 326, Post Office Box 2448, Richmond, VA 23218). The application can be found on-line at: ADAP Forms and Brochures.
- Clients may call the Medication Eligibility Hotline (1-855-362-0658), and staff will help with the application process. The application will be mailed to the client to sign and provide documents verifying income. The application can be returned to VDH in the postage-paid envelope that will be included.
- Application Process: To enroll in ADAP clients must apply through VDH ADAP Central Office or through the Virginia Commonwealth University Health Systems (VCUHS) Financial Services (if clients receive services there). Applicants will be given thirty days (30) to respond to the first request for documents. A second request will be made after 30 days if the needed documents have not been received. Applicants who do not respond after sixty days (60) will be deemed non-responsive in providing the completed ADAP application process and would need to re-submit a complete application to be approved for ADAP.
- The ADAP application is used to apply for all ADAP Service Options: Direct ADAP, the Medicare Part D Assistance Program (MPAP), the Health Insurance Marketplace Assistance Program (HIMAP) and the Insurance Continuation Assistance Program (ICAP).
- When approved by the client, the ADAP Central Office staff will work with client advocates (case managers, local health department ADAP coordinators, social workers) to assist with and complete the application.