Ohio HIV Drug Assistance Program (OHDAP)
The Ohio Department of Health (ODH) administers the Ohio HIV Drug Assistance Program (OHDAP), the HIV Health Insurance Premium Payment Program (HIPP) and the Ohio HIV Medicaid Spenddown Payment Program (OHMSDP).
OHDAP formulary provides medications to treat HIV and HIV-related conditions. This program is the payer of last resort. For eligible participants, HIV-related medications are provided free of charge. The medications are obtained through a specialty mail-order pharmacy to ensure confidentiality and to ensure all geographic areas of Ohio have equal access to this service. To be eligible, an applicant must re-enroll at the beginning of each enrollment period, be a resident of Ohio, be HIV positive, and meet financial-eligibility guidelines.
OHDAP Formulary Eligibility and Enrollment
To be eligible for the OHDAP formulary program, the applicant must:
- Submit a complete application and demonstrate a willingness to sign all forms and to provide necessary documentation.
- Be a resident of Ohio.
- Have a monthly gross income that meets OHDAP Financial Eligibility Guidelines (this income amount is adjusted for family size). This form should become available in April of each year. Applicants with an income at or below the federal poverty level are required to have an ODH-Approved Part B Medical Case Manager who can assist them in accessing all eligible services.
- Provide proof of monthly income (for the applicant, as well as the applicant's legal spouse and/or dependents). This includes copies of pay stubs for the most recent 30 consecutive days of employment, Social Security Income award letters, copies of unemployment compensation stubs, etc.
- For the self-employed: provide a copy of an IRS Income Tax Transcript for the most recent tax year. The form to obtain the transcript is Form 4506T and is available at the IRS Web site. Step-by-step instructions are also available by following the IRS transcript request instructions.
Any individual found to be submitting fraudulent information may be expelled from this and other HIV Care Services Section programs.
An OHDAP formulary of approved medicines is provided to all program participants and interested parties. The OHDAP program allows two refills for each prescription submitted to the pharmacy. Your doctor must call in a new prescription every three months. When it is time for a refill, the program’s contracted pharmacy will call you to see if there are any changes regarding your account. For the OHDAP program, there is no co-payment required. A 30-day supply of your approved medications will be mailed to you each month of your enrollment in the program. Be aware, however, that if your enrollment with OHDAP ends, your medications will not be paid for, even if you have refills left. Please carefully follow all instructions from OHDAP staff and from the pharmacy.
HIV Health Insurance Premium Payment Program (HIPP)
The Ohio Department of Health (ODH) administers the HIPP program for persons living with HIV. The HIPP program makes direct premium payments for consumers to continue existing health insurance policies.
OHIO HIV Medicaid Spenddown Payment Program (OHMSDP)
The OHMSDP or “spenddown program” enables individuals to access “public health insurance” with the payment of a “spenddown” to the Medicaid program. Individuals must have previously applied for Medicaid with their county Department of Job and Family Services and have an open Medicaid case with a monthly “spenddown” already determined. The Medicaid program offers prescription drug coverage, physician office visits, hospitalization, and dental care services.
HIPP and OHMSDP Eligibility and Enrollment
The HIPP and Spenddown Programs are available to individuals who meet the following eligibility requirements:
- A complete application and demonstrate a willingness to sign all forms and provide necessary documentation.
- A resident of Ohio.
- Monthly gross income of less than with "or equal to 300 percent of the federal poverty level. The amounts increase based on family size.
- Proof of monthly income (for yourself as well as your spouse and dependents). This includes copies of pay stubs for 30 consecutive days, income award letters, copies of unemployment compensation stubs, etc.
- A physician’s verification of HIV infection and lab results (viral load and CD4 counts) no older than 6 months from the date of your application to OHDAP.
- For the self-employed: Provide a copy of an IRS Income Tax Transcript for the most recent tax year.
- For HIPP: Current primary health insurance coverage or eligibility for continued coverage (COBRA), the policy must include prescription drug coverage that is as good or better than OHDAP can provide.
- A signed Health Insurance Portability and Accountability Act (HIPAA) release granting permission to speak with the insurance company.
The covered individual is responsible for notifying ODH of any changes in their income status, mailing address, insurance coverage, insurance premium rate and other information as necessary to maintain program eligibility. Failure to notify ODH may affect your enrollment and/or result in an interruption of services. This program must be the payer of last resort.
Any client found to be knowingly submitting fraudulent information may be expelled from this and other HIV Care Services programs for a period of up to 12 months.
For more information, please contact:
Ohio HIV Drug Assistance Program (OHDAP)
HIV Care Services Section
Ohio Department of Health
246 N. High Street
Columbus, OH 43215