ADAP FAQ 31-36 Flashcards
Can someone with restricted Medicaid get an ADAP/ADAP Plus card?
No. Someone with “restricted Medicaid” has Medicaid, which pays for all the services that ADAP/ADAP Plus does and many additional services for which ADAP/ADAP Plus does not pay. The difference between regular Medicaid and restricted Medicaid is that the participant can only receive services from one specific doctor, pharmacy and hospital.
How should someone decide whether to apply for Medicaid or ADAP/ADAP Plus?
Most people apply online for Medicaid through the New York State of Health (some may not, see below). If this would get the client the fastest access to comprehensive care, that is the best option.
People who are applying for Medicaid with a Spend-down cannot do this on-line. They will have to apply with a paper application at a Medicaid office. In addition, some people were not told that they could apply online, and have already filed a paper application. These clients will have a “pending Medicaid” status, which means they can go to the doctor while waiting for their application to be processed. HIV medications are so expensive that most pharmacies will not fill their prescriptions until they have active Medicaid.
If an HIV-positive person is applying with a paper application for Medicaid or Medicaid Spenddown, they should also apply for ADAP/ADAP Plus.
While their paper application is being processed, ADAP can process their ADAP/ADAP Plus application. In most cases, clients can receive an active ADAP/ADAP Plus number the same day. They can use it to pay for prescriptions and other services until their Medicaid is active. When their Medicaid becomes active, ADAP is turned of
If someone who is HIV-positive has lost their Medicaid, are they eligible for an ADAP/ADAP Plus card?
If their Medicaid has been terminated or is no longer active, they should apply for ADAP/ADAP Plus to pay for outpatient care and prescriptions while working to reinstate their Medicaid.
If they have active Medicaid, they are not eligible for ADAP/ADAP Plus. If their Medicaid is active, but they lost their Medicaid card, their Medicaid office should be able to replace their card quickly. They can continue to receive Medicaid services while waiting for their card.
I have regular Medicaid, but I can’t get Medicaid to pay for all the services I need.” Can this applicant have an ADAP card just to pay for the additional services?
No, all services covered by the Uninsured Care Programs are covered by Medicaid. Clients with comprehensive Medicaid are not eligible for services through the ADAP/ADAP Plus Program
If someone had ADAP/ADAP Plus in the past, but hasn’t used the Programs (because they had Medicaid or health insurance, etc.), how can their ADAP/ADAP Plus be reinstated?
Contact UCP to confirm that the person had ADAP/ADAP Plus in the past. If it has been a considerable time since their card was active, call the ADAP hotline to ask what documents will be needed to get them active ADAP.
How long does it take to reactivate eligibility for ADAP/ADAP Plus?
Call the UCP office and ask what documentation is needed. If it has been a short period since the applicant was active, a new application may not be required. If updated documents are needed for proof of residency, income or insurance status, send those as soon as possible by portal or fax to the UCP office in Albany. The UCP staffer can work flexibly with the case manager to quickly reactivate the client, and may be able to do so the same day.
