Iowa Admin. Code r. 641-11.87

Current through Regsiter Vol. 46, No. 26, June 12, 2024

Rule 641-11.87 - Eligibility requirements

(1) An applicant is eligible to participate in the ADAP Medication assistance program if the applicant:

a. Applies for enrollment in ADAP on a form provided by the department;

b. Has no health insurance to cover the cost of the drugs that are or may become available from ADAP;

c. Is currently being prescribed a drug on the ADAP formulary;

d. Has an annual gross household income that is less than or equal to 200 percent of the poverty level as determined by the most recent federal poverty guidelines published annually by the United States Department of Health and Human Services for the size of the household (this income shall be determined after a $500 work-related allowance is deducted from the monthly gross salary of an employed person with HIV/AIDS);

e. Has a medical diagnosis of HIV infection or AIDS or is an unborn infant or an infant under 18 months of age who has an HIV-infected mother; and

f. Is a resident of Iowa.

(2) An applicant is eligible to participate in the ADAP health insurance assistance program if the applicant:

a. Applies for enrollment in ADAP on a form provided by the department;

b. Has creditable health insurance coverage;

c. Is currently being prescribed a drug on the ADAP formulary;

d. Has an annual gross household income that is less than or equal to 400 percent of the poverty level as determined by the most recent federal poverty guidelines published annually by the United States Department of Health and Human Services for the size of the household;

e. Has a medical diagnosis of HIV infection or AIDS or is an unborn infant or an infant under 18 months of age who has an HIV-infected mother; and

f. Is a resident of Iowa.

(3) For purposes of paragraphs 11.87(1) "d " and 11.87(2) "d , " an individual may report annual household income by using actual household income for the most recent 12 months or by using estimated annual household income determined by multiplying the current monthly household income by 12.

Iowa Admin. Code r. 641-11.87

ARC 0755C, IAB 5/29/2013, effective 7/3/2013