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 and has not opted out of health insurance coverage to which the individual is eligible; 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 unaffordable, 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 unaffordable, as described in subsections (4)(b) and (c).