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 FPL	2 ADAPs*
101 to 200% FPL	12 ADAPs
201 to 300% FPL	21 ADAPs
Over 300% FPL	19 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.