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AIDS Drug Assistance Program (ADAP) Eligibility Criteria


The CARE Act gives States the authority to determine financial and medical eligibility criteria for participation in ADAPs. Individuals with HIV disease who do not have another source of payment must demonstrate financial need, which States typically define using a multiple of the Federal Poverty Level (FPL). For help in determining the size and content of ADAP formularies, most States (50) have established Advisory Groups to assist with decision making on these and other difficult issues. These groups include expert clinicians, public health officials and planners, medical ethicists, and representatives of consumers and service providers.

All States require documentation of HIV status for ADAP enrollment. At present, nine States also require individuals to demonstrate disease progression (e.g., a lab test showing a CD4 count of 500 or less). In addition, four ADAPs have specific criteria for accessing protease inhibitors and/or antiretrovirals.

The table below summarizes financial eligibility criteria. Fourteen States have established income eligibility at 200 percent or less of FPL. (See State-by-State description of criteria below).

Rapid growth in client enrollment, utilization, and expenditures has resulted in major challenges to States as they try to promote access to treatment while ensuring that ADAPs remain fiscally sound. State responses include: maximizing resources through different cost-savings strategies, establishing representative advisory bodies to help with difficult program decisions; including defining eligibility criteria, and seeking additional funds from State legislatures or other resources.


Financial Eligibility Criteria

Criteria as Percentage of Federal Poverty Level (FPL)Number of States/Grantees
100% or below FPL2 ADAPs*
101 to 200% FPL12 ADAPs
201 to 300% FPL21 ADAPs
Over 300% FPL19 ADAPs
* Utah uses a sliding fee scale for incomes from 201-500% FPL.

2003 Federal Poverty Level is $9310/year per individual, $12,490 for a family of two.

ADAP Eligibility Criteria, FY 2004

Grantee HIV+ Diagnosis CD4 Count <500 Specific Criteria for PIs Financial Eligibility (% of FPL)
Alabama yes     250
Alaska yes     300
American Samoa (2)       N/A
Arizona yes     300
Arkansas yes yes   300
California yes     400
Colorado yes     300
Connecticut yes     400
Delaware yes     500
D.C. (1) yes     400
F. Sts. Micronesia (2)       N/A
Florida yes yes   350
Georgia yes <350   300
Guam yes     100
Hawaii yes     400
Idaho yes     200
Illinois yes     400
Indiana yes     300
Iowa yes     200
Kansas yes     300
Kentucky yes     300
Louisiana yes yes yes 200
Maine yes     300
Marshall Islands (2)       N/A
Maryland yes     400
Massachusetts yes     556
Michigan yes     450
Minnesota yes     300
Mississippi yes     400
Missouri yes     300
Montana yes     330
Nebraska yes     200
Nevada yes     400
New Hampshire yes     300
New Jersey yes     500
New Mexico yes     300
New York yes     487
North Carolina yes     125
North Dakota yes     400
Northern Mariana (2)       N/A
Ohio yes yes   500
Oklahoma yes     200
Oregon (5) yes     200
Pennsylvania yes     380
Puerto Rico yes yes yes 200
Republic of Palau (2)       N/A
Rhode Island yes     400
South Carolina (4) yes     300
South Dakota (1) yes yes   300
Tennessee yes   yes 300
Texas yes yes   200
Utah (3) yes     100
Vermont yes     200
Virgin Islands yes     200
Virginia yes yes yes 300
Washington yes     300
West Virginia yes     250
Wisconsin yes     300
Wyoming yes     200

Based on projections from States in their Ryan White CARE Act FY 2004 Title II grant applications ADAP Profile: (1) South Dakota does not include protease inhibitors on their formulary (2) Developing ADAP (3) Utah uses a sliding fee scale for incomes from 201-500% FPL (4) South Carolina uses a sliding fee scale for incomes from 301% to 550% FPL (5) Oregon uses a sliding scale that is tied to the annual income cap amount.

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See Also
2014 National ADAP Monitoring Project Annual Report (PDF)
ADAP Waiting List Update: 35 People in 1 State as of July 23
More on ADAP