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Addressing Cost Barriers

Federal Resources for HIV Care

If you’ve just been diagnosed with HIV, you may have concerns about how to pay for your treatment. HIV treatment is expensive—but there are resources to help you get the care you need. These programs provide funding to care providers to serve people living with HIV:

  • The Ryan White HIV/AIDS Program (Formerly the Ryan White Care Act)—Channels Federal funding through state and local governments and community-based organizations to provide HIV-related health services for individuals who could not otherwise afford to pay for them. The program is run by the Health Resources and Services Administration (HRSA) and serves over half a million people each year. It is the largest recipient of Federal domestic HIV/AIDS funding—$2.1 billion in 2008. For more information, see HRSA’s The Ryan White HIV/AIDS Program.
  • AIDS Drug Assistance Program (ADAP)—Provides medications for the treatment of HIV disease. Program funds may also be used to purchase health insurance for eligible clients and for services that enhance access to, adherence to, and monitoring of drug treatments. This service is provided under The Ryan White Program, part B. For more information, see HRSA’s Title II: AIDS Drug Assistance Program.
  • Medicaid—Pays for healthcare for low-income individuals who meet eligibility requirements. Medicaid provides financial assistance for outpatient and inpatient care, as well as for prescription drugs. It is a state-administered program, and each state sets its own guidelines for eligibility and services. For more information, see the Center for Medicare and Medicaid Services’ Medicaid Program–General Information.

    In June 2011, the Centers for Medicare & Medicaid Services (CMS) released a State Medicaid Director letter (PDF, 661KB) providing guidance to inform States of opportunities to provide Medicaid coverage to individuals living with HIV in support of President Obama’s National HIV/AIDS Strategy. This guidance informs States on how to apply for opportunities in the Medicaid program that allow for flexibility to improve care and care coordination and offer options to treat individuals living with HIV (including individuals living with AIDS, which refers to individuals living with an advanced stage of the HIV disease) in the community.  States may choose to apply for one or more of six options to extend coverage to individuals living with HIV. These coverage and service design opportunities may assist States in increasing access to care for individuals living with HIV, provide alternatives that could alleviate the current burden to AIDS Drug Assistance Programs (ADAP), and help States make progress towards expanding coverage and providing access in accordance with the Affordable Care Act requirements.
  • Medicare—A Federal health insurance program that supports medical care for those who qualify based on work history, age, and disability status. Medicare coverage for eligible individuals includes outpatient care, prescription drugs, and inpatient hospital care. For more information, see Medicare.gov.

Non-Federal Resources

  • Common Patient Assistance Program Application—Patient Assistance Programs (PAPs) are administered by numerous drug companies and foundations and offer free or reduced cost HIV drugs to people with low-incomes who do not qualify for any other insurance or assistance programs, such as Medicaid or AIDS Drug Assistance Programs (ADAPs). Different company programs have different eligibility criteria, often based on the Federal Poverty Level (FPL) designation. In her speech at the XIX International AIDS Conference in July 2012 HHS Secretary Kathleen Sebelius announced that HHS had joined together with the National Alliance of State and Territorial AIDS Directors and the eight largest AIDS drug companies to create a single application form for AIDS medications offered through their patient assistance programs. This application (PDF 944KB) will make it far easier for patients to get their life-saving drugs, and all eight companies – Abbot Laboratories, Boehringer Ingelheim, Bristol Myers Squibb, Gilead, Genentech, Johnson and Johnson, Merck, and ViiV – have agreed to  begin accepting the form starting September 12, 2012.
  • Private Health Insurance—If you have healthcare insurance through your employer (or have purchased it yourself), your insurance company may pay for your HIV care. But it’s important to know what your provider will (and won’t) cover and to research the Federal and state laws that regulate private health insurance and protect your healthcare rights.

For more information, see HRSA’s Learn More About Health Care.

Related Topics on AIDS.gov

Frequently Asked Questions

If I have private insurance, can I access services like Medicare, Medicaid, and ADAP to help pay for my HIV care?

In general, if you have private insurance and/or health insurance provided by your employer, you will not be eligible for state or Federal benefits. There may be exceptions, however. Check with your local AIDS service organizations for more information.

Last revised: 09/12/2012