While Medicaid has been the gold standard for health insurance coverage for those living with HIV in NYS for over 35 years the program is at risk for dramatic reductions in funding and/or eligibility in the near future. Providers and Plans would be wise to familiarize themselves with alternatives available to PLWH in NYS if they no longer qualify for Medicaid. Patients will need to apply individually. Providers will need to confirm that their facilities are participating. Pharmacy will also need to apply.
A summary of the following programs can be found on the New York Uninsured Care Program web site which can be found on the links below:
The NYS Department of Health, AIDS Institute offers five programs to provide access to health care (ADAP, Primary Care, Home Care, APIC and PrEP-AP) for New York State residents who are uninsured or underinsured. The Programs use the same application form and enrollment process, additional forms are required for Home Care and APIC.
ADAP – Pays for medications for the treatment of HIV/AIDS and opportunistic infections. ADAP can help people with no insurance, partial insurance, Medicaid Spend-down/Surplus or Medicare Part D.
ADAP Plus (Primary Care) – Pays for outpatient primary care services through participating clinics, hospitals, laboratory providers, and private practitioners.
ADAP Plus Insurance Continuation (APIC) – Pays for cost effective health insurance premiums for eligible participants.
The Home Care Program – Pays for home care services for chronically medically dependent individuals as ordered by their doctor. The program covers services through enrolled home health care agencies. ADAP Plus Insurance Continuation (APIC) – Pays for cost effective health insurance premiums for eligible participants.
Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) – Pays for outpatient services for eligible participants for the care and monitoring necessary to successfully use PrEP to prevent HIV infection.
Applying for Services: This eligibility assessment is used to determine eligibility for the AIDS Drug Assistance Program(ADAP), ADAP Plus(primary care), HIV Home Care, ADAP Plus Insurance Continuation (APIC) and the Pre-Exposure Prophylaxis Assistance Program(PrEP-AP). Additional paperwork is needed for Homecare and ADAP Plus Insurance Continuation. A separate medical eligibility form must be submitted by your clinician.
https://nyucp.providecm.net/home/index
https://www.health.ny.gov/diseases/aids/general/resources/adap/