ENROLLMENT INFORMATION + APPLICATION

ELIGIBILITY REQUIREMENTS
To be eligible to enroll in the Massachusetts HIV Drug Assistance Program, you must:
•    Live in Massachusetts
•    Be HIV-positive
•    Meet income eligibility guidelines: A gross annual income not exceeding 500 percent of the federal poverty level ($62,450 as of January 25, 2019, with an allowance of $4,420 per dependent)

U.S. citizenship is not required.

HOW TO ENROLL FOR THE FIRST TIME
To enroll in HDAP, you need to fill out a standard application (the “long form”) and submit it along with proof that you live in Massachusetts and proof of your current income (see application instructions below for details). Because HDAP is a “payer of last resort,” you will also need to submit an application to MassHealth or other insurance programs to see if you are eligible in order to enroll in HDAP. If you have a case manager, he or she can help you complete the applications.

Once you are enrolled in HDAP, you will need to recertify your information every six months to stay active in the program (more details about HDAP’s recertification process included in next section).

Fax your completed and signed HDAP Enrollment Application with all supporting documentation to 617.502.1703.

Or, mail the completed and signed form with all supporting documentation to: 

Community Research Initiative of New England/HDAP
The Schrafft’s City Center
529 Main Street
Suite 301
Boston, MA 02129

Click on each link to download a PDF. The English language application is a fillable PDF, but you must first download the PDF in order to save any information that you fill in.

HDAP English Language Application

HDAP English Language Application Instructions, Client Agreement, and Grievance Procedure

HDAP Spanish Language Application

HDAP Application for Incarcerated Individuals

HOW TO RECERTIFY

As of May 1, 2019, HDAP will accept a one-page self-attestation (short) form at six months recertification as a method to verify ongoing client eligibility for HDAP and the Comprehensive Health Insurance Initiative (CHII).

Previously, individuals enrolling in HDAP were required to complete and submit HDAP’s standard application (the “long form”) every six months to recertify. With this change, clients are now able to submit a “short form” — featuring reduced documentation requirements — every other recertification cycle. In order to do so, clients must not experience any lapses in coverage.

If you need help with the cost of medications and/or health insurance premiums, here’s how to apply to HDAP:

At the time of your... You need to complete and submit the: 
Initial (first-time) HDAP enrollment HDAP Standard (long form) application
Recertification (six months later)  HDAP Short form
Next recertification (six months later) HDAP Standard (long form) application
Next recertification (six months later) HDAP Short form
... and so on.   

If you have a gap in HDAP coverage for any reason, you will be required to recertify with HDAP using the standard application.

You can only use the short form to recertify if you have not experienced a gap in your HDAP coverage.

HDAP Self-Attestation (Short Form) Application - English

HDAP Self-Attestation (Short Form) Application - Spanish

HDAP Self-Attestation (Short Form) Instructions - English 

HDAP Self-Attestation (Short Form) Instructions - Spanish

HDAP Self-Attestation (Short Form) Webinar slides

HDAP Self-Attestation Webinar recording

HDAP Self-Attestation Webinar questions

HDAP APPLICATION REMINDERS

  • Please pay careful attention to requests for information or notifications from HDAP staff, especially the Notice of Recertification letter sent to you or your case manager eight weeks prior to your HDAP termination date. For example, these notices will indicate whether you need to submit the complete long OR short form at the time of your recertification.
  • Fill out the application clearly and completely. We cannot process applications with incomplete or missing information.
  • HDAP recommends that clients and case managers fax applications and other documents only once to 617.502.1703. Please include a cover sheet with any documents you fax. HDAP receives all documents via an electronic system and processes them in the order received. It can take between 24-48 hours before a fax is confirmed as received in our system. If you are concerned that a fax may have not gone through or been received by HDAP, please call HDAP (617.502.1700) 24-48 hours after the fax was sent to confirm if it was received. Please note that faxing documents multiple times adds more documents to the system for HDAP staff and causes delays in processing for all clients. We highly recommend that you retain a copy of all application and documents faxed to HDAP including the fax confirmation page with the date, time, and number of pages in your fax. This information can be used to facilitate communication with HDAP regarding your documents.
  • For URGENT HDAP coverage requests, please contact HDAP at 617-502.1700 after the fax has been sent and inform the HDAP staff of the date, time, and number of pages you have faxed for URGENT processing. In addition, please include on your fax cover page that this document needs URGENT processing and the reason why (e.g. out of medications, newly diagnosed, etc.).
  • Make a copy of your application for your records.
  • Once we receive your completed application materials, please allow at least two weeks for your application to be processed. You will be notified by mail of our decision.
  • All information submitted as part of your HDAP application is kept strictly confidential.
  • Once you are enrolled in HDAP, you will need to recertify your information every six months to stay active in the program.

For more information on the status of pending applications/forms or missing documents, please contact HDAP staff at 617.502.1700.