Ariz. Admin. Code § 9-6-403

Current through Register Vol. 30, No. 50, December 13, 2024

Section R9-6-403 - Eligibility Requirements

An individual is eligible to enroll in ADAP if the individual:

1. Has a diagnosis of HIV infection from a physician, registered nurse practitioner, or physician assistant;

2. Is a resident of Arizona, as established by documentation that complies with R9-6-404(A)(8);

3. Has an annual household income that is less than or equal to 400% of the poverty level; and

4. Satisfies one of the following:

a. Has no health insurance coverage;

b. Has inadequate health insurance coverage, which may include Medicare or an AHCCCS health plan, limiting the ability of the individual to obtain drugs, such as health insurance coverage that:

i. Does not cover drugs,

ii. Does not include on its formulary at least one of the drugs prescribed for the individual ,

or

iii. Requires the use of specific pharmacies or higher co-payments for obtaining a drug;

c. Has health insurance that is unaffordable because premiums exceed 9.5% of the applicant's annual household income;

d. Is an American Indian or Alaska Native who:

i. Is eligible for, but chooses not to use, the Indian Health Service or a clinic operated by a sovereign tribal nation to receive drugs; and

ii. Either has no other health insurance coverage or has other health insurance coverage that is inadequate or unafford-able, as described in subsections (4)(b) and (c)

; or

e. Is an individual who has served in the United States Armed Forces and who:

i. Is eligible for, but chooses not to use, Veterans Health Administration benefits to receive drugs; and

ii. Either has no other health insurance coverage or has other health insurance coverage that is inadequate or unafford-able, as described in subsections (4)(b) and (c).

Ariz. Admin. Code § R9-6-403

Adopted as an emergency effective January 12, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-1). Emergency expired. Readopted without change as an emergency effective May 9, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-2). Amended and readopted as an emergency effective August 8, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-3). Emergency expired. Readopted without change as an emergency effective November 16, 1988, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 88-4). Emergency expired. Amended subsection (B) and adopted as a permanent rule effective May 22, 1989 (Supp. 89-2). Amended as an emergency effective August 8, 1990, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 90-3). Emergency expired. Emergency amendments re-adopted without change effective November 19, 1990, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 90-4). Emergency expired. Emergency amendments re-adopted without change effective February 28, 1991, pursuant to A.R.S. § 41-1026, valid for only 90 days (Supp. 91-1). Emergency expired. Renumbered from R9-6-803 and amended effective October 19, 1993 (Supp. 93-4). Former Section R9-6-403 renumbered to R9-6-404; new Section R9-6-403 renumbered from R9-6-402and amended by final rulemaking at 8 A.A.R. 1953, effective April 3, 2002 (Supp. 02-2). Amended by final rulemaking at 13 A.A.R. 3329, effective November 10, 2007 (Supp. 07-3). Amended by final rulemaking at 25 A.A.R. 3614, effective 12/3/2019.