NYSDOH Uninsured Care Programs Covered Services

ADAP Plus

Primary Care/Outpatient Services

  • Comprehensive Medical Evaluation (1 per treatment year)
  • Disease Monitoring-Routine and Intermediate Visits
  • Infusion Chemotherapy
  • Transfusions

Clinic Visits & Physicians Visits (30 per treatment year unless otherwise specified)

  • Primary Care
  • Neurology
  • Dermatology
  • Family Planning
  • Nutritional Assessment & Counseling (symptomatic illness 12 per year, asymptomatic 4 per year)
  • OB/GYN
  • Pediatric
  • Specialty Medicine
  • Oncology
  • Directly Observed Therapy
  • Opthamology
  • Dental & Oral Surgery
  • Mental Health (24 visits per year)

Other Services

  • Ambulatory Surgery
  • Laboratory Services
  • Viral Load Test
  • Genotypic and Phenotypic Resistance Testing (3 per treatment year)
  • Hepatitis C Testing

Vitamins and Minerals and Oral Nutritional Supplements

  • Multiple Vitamins & Minerals
  • Iron Supplements
  • Zinc
  • Vitamin B-12 (IM and sublingual only)
  • Beta Carotene
  • Lactaid
  • Vitamin B-6
  • Folinic Acid
  • Magnesium Glutamate
  • Vitamin C
  • Folate
  • Selenium
  • Potassium
  • Calcium Carbonate

Oral nutritional supplements which are included in the Medicaid Formulary (including pediatric) are covered. Supplements, vitamins, and minerals will be covered only with a prescription and when dispensed at an ADAP enrolled pharmacy.

Home Care Program

  • Skilled Nursing
  • Home Health Aide
  • Homemaker Service
  • Nutritional Assessment and Counseling
  • Adult Day Health Care
  • Limited Rehabilitative Therapy (3 visits)
  • Personal Care Aide
  • Durable Medical Equipment
  • IV Administration and Supplies
  • A maximum lifetime benefit of $30,000 is allowed for home care services

PrEP-AP

  • Clinic and Physicians Visits
  • Monitoring Services
    • Third or fourth generation HIV test
    • HIV viral load test if symptomatic
    • Basic Metabolic Panel
    • Urinalysis
    • Screening for Sexually Transmitted Infection: GC, Chlamydia, Syphilis
    • Serum creatinine and calculated creatinine clearance
    • Serology for Viral Hepatitis A, B, and C
    • Pregnancy Test
    • HCV serology for MSM, IDUs and those with multiple partners

Excluded Services

  • Pharmacy (Drugs not included in ADAP formulary)
  • Emergency room
  • Substance Abuse & Alcoholism Services/Methadone Maintenance
  • Ancillary Services (Any service, lab, or procedure not included in the clinic visit)
  • Rehabilitative Therapy (Vocational, Physical, Speech, etc)
  • Case Management/Social Work
  • Psychiatric/Mental Health (extended visits)
  • Inpatient Services

Drugs Listed on Separate ADAP Formulary