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

GranteeHIV+ DiagnosisCD4 Count <500Specific Criteria for PIsFinancial Eligibility (% of FPL)
Alabamayes  250
Alaskayes  300
American Samoa (2)   N/A
Arizonayes  300
Arkansasyesyes 300
Californiayes  400
Coloradoyes  300
Connecticutyes  400
Delawareyes  500
D.C. (1)yes  400
F. Sts. Micronesia (2)   N/A
Floridayesyes 350
Georgiayes<350 300
Guamyes  100
Hawaiiyes  400
Idahoyes  200
Illinoisyes  400
Indianayes  300
Iowayes  200
Kansasyes  300
Kentuckyyes  300
Maineyes  300
Marshall Islands (2)   N/A
Marylandyes  400
Massachusettsyes  556
Michiganyes  450
Minnesotayes  300
Mississippiyes  400
Missouriyes  300
Montanayes  330
Nebraskayes  200
Nevadayes  400
New Hampshireyes  300
New Jerseyyes  500
New Mexicoyes  300
New Yorkyes  487
North Carolinayes  125
North Dakotayes  400
Northern Mariana (2)   N/A
Ohioyesyes 500
Oklahomayes  200
Oregon (5)yes  200
Pennsylvaniayes  380
Puerto Ricoyesyesyes200
Republic of Palau (2)   N/A
Rhode Islandyes  400
South Carolina (4)yes  300
South Dakota (1)yesyes 300
Tennesseeyes yes300
Texasyesyes 200
Utah (3)yes  100
Vermontyes  200
Virgin Islandsyes  200
Washingtonyes  300
West Virginiayes  250
Wisconsinyes  300
Wyomingyes  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.