The Uninsured Care Programs in New York State are dedicated to providing crucial access to free health care services for residents who lack health insurance or are underinsured. These programs, often referred to as Adap Uninsured Care Programs due to the prominence of the AIDS Drug Assistance Program, encompass a wide array of services designed to support individuals, particularly those living with or at risk of HIV/AIDS. These services range from essential medications and outpatient primary care to home care and even assistance with insurance premiums, and preventative measures like Pre-Exposure Prophylaxis (PrEP). The core mission of these programs is to collaborate closely with healthcare providers and individuals to navigate and facilitate access to various payment options for healthcare services and medications.
Operating Hours: Monday – Friday, 9:00 AM – 5:00 PM
Contact Information:
- In State – Toll Free: 1-800-542-2437 or 1-844-682-4058
- Out of State: (518) 459-1641
Please note that the Office of Uninsured Care Programs will be closed on the following holidays in 2025: Monday, February 17, Monday, May 26, Thursday, June 19, Friday, July 4, Monday, September 1, Monday, October 13, Thursday, November 11, Thursday, November 27, and Thursday, December 25.
Navigating the Uninsured Care Programs Portal
To streamline the application and recertification process, the Uninsured Care Programs have launched an online portal. This secure platform allows both new applicants and existing participants to efficiently manage their documents.
For New Applicants: The portal enables first-time applicants to securely complete and submit their program applications along with all necessary supporting documentation. This includes medical forms, income verification, and proof of New York State residency.
For Existing Participants: Current program participants can utilize the portal to conveniently submit their recertification documents, ensuring continued access to vital healthcare services.
This digital portal represents a significant step in making the ADAP uninsured care programs more accessible and user-friendly for all eligible New York residents.
ADAP Drug Formulary and Service Coverage Details
The Uninsured Care Programs, particularly through the AIDS Drug Assistance Program (ADAP), offer a comprehensive drug formulary and cover a range of essential services.
Cabenuva Coverage Instructions:
For providers enrolled in ADAP or ADAP Plus, the program facilitates the use of their existing Cabenuva inventory. It is important to note that medications acquired under the Public Health Service (PHS) Section 340B cannot be used for New York State ADAP participants.
To ensure seamless access to Cabenuva, prescribing practitioners should contact an enrolled pharmacy to arrange direct shipment to their office. The pharmacy will then handle billing to the ADAP participant’s insurance and/or ADAP. Participants will incur no out-of-pocket expenses for Cabenuva when filled at an enrolled pharmacy. For claim submissions under a participant’s medical benefit, please contact the program at 1-800-732-9503, extension 2, to speak with a supervisor.
Coverage for Office Visits and Administration Fees under ADAP Plus:
To eliminate out-of-pocket costs for office visits and administration fees for ADAP Plus participants, providers must be part of the ADAP Plus network. Enrolled providers can directly bill ADAP Plus for these services. If a provider is not within the ADAP Plus network, the participant will be responsible for both the office visit fee and the drug administration costs.
For any inquiries regarding ADAP and ADAP Plus coverage, please contact 1-800-542-2437 or 1-844-682-4058.
Alt text: A person uses a laptop to access the online portal for New York State ADAP Uninsured Care Programs, simplifying healthcare application and recertification processes.
Summary of Uninsured Care Programs Eligibility
You may be eligible for assistance from the Uninsured Care Programs if you meet the following criteria:
- You are a resident of New York State.
- You are uninsured or have health insurance but require help with out-of-pocket expenses such as copays and deductibles.
- Your household income is less than 500% of the Federal Poverty Level (FPL).
To apply for ADAP uninsured care programs, you can either apply independently or seek assistance from your healthcare provider. Regardless of the application method, you will need to provide documentation verifying your income, New York State residency, and copies of any health insurance cards you possess. Click here for examples of how to document your residency and income. Complete applications are typically processed within 1-3 business days, and in many instances, on the same day.
If you need clarification on documenting your address, income, and/or health insurance, or have questions about the enrollment process, please contact the Uninsured Care Programs toll-free at 1-800-542-2437 or 1-844-682-4058.
Key Programs Under Uninsured Care
The Uninsured Care Programs encompass several distinct programs tailored to specific healthcare needs:
AIDS Drug Assistance Program (ADAP)
The AIDS Drug Assistance Program (ADAP) is central to the uninsured care programs, offering free medications for treating HIV/AIDS and related opportunistic infections. These medications are vital for improving the longevity and managing the symptoms of HIV infection. ADAP extends its support to individuals with partial insurance coverage and those with Medicaid spenddown requirements, ensuring broad access to necessary treatments.
ADAP Plus (Primary Care)
ADAP Plus (Primary Care) broadens the scope of services by providing free primary care at designated clinics, hospital outpatient departments, physician offices, and lab vendors. The services include essential ambulatory care for medical evaluations, early intervention strategies, and ongoing treatment plans, forming a robust primary care safety net.
HIV Home Care Program
For individuals with chronic medical dependencies, the HIV Home Care Program offers crucial coverage for home care services as prescribed by a physician. This includes skilled nursing care, home health aide services, intravenous therapy, necessary medications and supplies, and durable medical equipment, all delivered through enrolled home care agencies.
ADAP Plus Insurance Continuation Program (APIC)
The ADAP Plus Insurance Continuation Program (APIC) focuses on maintaining consistent healthcare coverage by paying commercial health insurance premiums for ADAP-eligible clients. APIC prioritizes comprehensive policies that offer full prescription and primary care coverage without restrictive annual coverage caps, ensuring stable access to healthcare.
Pre-Exposure Prophylaxis Assistance Program (PrEP-AP)
The Pre-Exposure Prophylaxis Assistance Program (PrEP-AP) is a vital preventative initiative. It reimburses eligible providers for a range of services provided to eligible individuals, including HIV testing, STI/STD testing, and supportive primary care services, all aligned with established PrEP clinical guidelines. This program is crucial in the broader effort to prevent HIV transmission.
Application Resources
For easy access to application forms, please use the links below:
Additional Resources
- Other Resources
- Uninsured Care Programs Provider Assurances & Agreements with Enrollment Form
- Uninsured Care Programs Provider/Service Manuals
For alternate format information requests, please email [email protected].
Address: (Insert Address if provided in original source)
This comprehensive suite of ADAP uninsured care programs in New York State stands as a critical resource, ensuring that vulnerable populations have access to the healthcare and medications they need, regardless of their insurance status or financial situation.
Alt text: A healthcare provider assists a patient in filling out application forms for ADAP Uninsured Care Programs, highlighting the support available for enrollment.
