Summary

AIDS Drug Assistance Programs (ADAPs), a component of the Ryan White Program, are the nation’s prescription drug safety-net for people living with HIV (PLWH), serving primarily low-income, people of color who have limited or no access to life-saving medications. ADAPs provide antiretroviral (ARV) medications, a critical component of HIV care today, to PLWH who would otherwise fall through the cracks in the larger U.S. health care system. ADAPs serve approximately one-quarter of all PLWH who are in care and delicately balance available program capacity and funding with client demand. As the number of PLWH in the U.S. has increased, largely due to advances in HIV treatment and increased HIV testing, the reliance on the Ryan White Program, and ADAPs specifically, has grown over time. The purpose of ADAPs, as stated in Ryan White Program legislation, is to:

…provide therapeutics to treat HIV disease or prevent the serious deterioration of health arising from HIV disease in eligible individuals, including measures for the prevention and treatment of opportunistic infections…

ADAPs accomplish this purpose through two main activities: by providing FDA-approved HIV and HIV-related prescription drugs and by paying for health insurance that includes HIV and HIV-related treatments. The predecessor to ADAPs began serving clients in 1987, when Congress first appropriated funds to help states purchase AZT, the only FDA-approved HIV antiretroviral drug at that time. In 1990, these federally-funded, state administered “AZT Assistance Programs” were incorporated into the newly created Ryan White Program under Title II (grants to states, now known as “Part B”). AZT Assistance Programs became a distinct component of the Ryan White Program in 1996, when they were introduced as “AIDS Drug Assistance Programs,” or ADAPs, as a component of Title II (now Part B) of the Ryan White CARE Act (now the Ryan White Program). The Ryan White Program is the nation’s third largest source of federal funding for HIV care and treatment, after Medicaid and Medicare.

Like all Parts of the Ryan White Program, ADAPs serve as “payer of last resort;” that is, they provide medications to, or pay for health insurance for, PLWH when no other coverage source or funding is available to do so. Since the inception of ADAP, there have been significant shifts in funding and client need. ADAPs continually seek to identify how they can meet client need and ensure program sustainability. At a time when ADAPs are able to document program stability, it is imperative that ADAP look back on how challenges were resolved and look ahead at client needs and determine ways to prepare for the future. ADAPs are at an unprecedented juncture of being able to target resources for populations that need them most, to partner with Ryan White Part B programs to ensure that the whole client’s needs are met, and to identify ways to bolster treatment to improve individual’s health.

Section One

The Importance of the Ryan White Program and ADAP

Overview of the Ryan White Program and ADAP

The Ryan White HIV Program (Ryan White Program), comprised of five “Parts,” provides comprehensive care to eligible clients with the majority of funding allocated to medical care and support services. The Ryan White Program received $2.3 billion in federal funding in federal fiscal year (FY) 2016. Part B of the Ryan White Program focuses grant funding to states and territories to provide 29 core medical and support services, including ADAP. ADAP was introduced as a line item in Title II (now Part B) of the Ryan White Program appropriation in 1996. The introduction of ADAP offered access to HIV antiretroviral (ARV) medications for low-income, under- and un-insured individuals. The Ryan White Program, including ADAP, is available in all 50 states, the District of Columbia, the Commonwealth of Puerto Rico, the U.S. Virgin Islands, American Samoa, the Federated States of Micronesia, Guam, the Northern Mariana Islands, Republic of Palau, and the Republic of the Marshall Islands.

Funding the Ryan White Program

Funding for the Ryan White Program is appropriated annually by Congress. The Health Resources and Services Administration’s HIV/AIDS Bureau (HRSA/HAB) administers the Ryan White Program and provides appropriated funding to states based on a formula and eligibility-based distribution mechanism. ADAPs are funded as a component part of the overall Part B program and are eligible to apply to receive three categories of funding: ADAP Earmark, ADAP supplemental drug treatment grants, and ADAP emergency relief funding. In FY2016, the Congressionally appropriated contribution to ADAP was $897.1 million. Based on local state and metropolitan area decisions, ADAPs can also receive federal funding via a transfer of federal funding from other Ryan White Program Parts (i.e., Part A, Part B). These transfers include funding from states’ Part B “base,” Part B supplemental, or metropolitan area Part A awards. In FY2016, these other federal funding contributions to ADAP totaled $102.8 million.

Federal funding alone does not support the needs of clients seeking services from ADAPs; federal funding for ADAP represents approximately half of the overall ADAP budget. Since their inception, ADAPs have relied upon additional funding support, including state contributions (money appropriated to the state HIV program or ADAPs specifically by state legislatures) and drug rebates (money that is returned to the state as a result of active filing of rebate claims with manufacturers, based on drug purchases). State contributions to ADAPs accounted for $119.9 million, or 6%, of the overall ADAP budget in FY2016. Drug rebates accounted for $801.2 million, or 40%, of the overall ADAP budget in FY2016.

The National ADAP Budget

FY2016 ADAP budgets ranged from $796 in the Marshall Islands to approximately $349 million in New York. By definition, all eligible jurisdictions (59) receive federal ADAP earmark funding based on a formula, but not all ADAPs received funding from other sources, which are often dependent on individual state and local planning, policy, and/or legislative decisions, as well as resource availability. In FY2016, three ADAPs received only federal earmark funding. The breakdown of other sources of funding for ADAPs can be found in the box to the right.

The overall composition of the national ADAP budget has changed since FY1996, the year in which the ADAP earmark began. The federal earmark now maintains a similar proportion of the budget, 26% of the budget in FY1996 to 39% in FY2016. State funding has declined as a proportion of the national ADAP budget (25% in FY1996 and 6% in FY2016) and drug rebates have risen from 6% in FY1996 to 40% in FY2016, and are now the largest source of revenue for ADAPs.

Since FY1996, the first year of the National ADAP Monitoring Project and the year in which highly active antiretroviral therapy (HAART) emerged as the new standard of care, the national ADAP budget from all sources has grown more than ten-fold (a 1,049% increase). The national budget has grown each year since 1996, but generally at slower rates since an initial jump between 1996 and 1997, when the federal appropriation more than tripled. From 1998–2016, the annual rate of increase for the national budget has averaged 9%, even with an overall decrease in FY2016 (6% decrease between FY2015 and FY2016).

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Chart 1

Total ADAP Budget, by Source, FY1996-FY2016

Total ADAP Budget, by Source, FY1996-FY2016 Total ADAP Budget, by Source, FY1996-FY2016

Chart 1 (Continued)

Total ADAP Budget, by Source, FY1996-FY2016

Chart 1 (Continued)

Total ADAP Budget, by Source, FY1996-FY2016

Table 1

State / Territory Part B FY2016 Total Budget ADAP FY2016 Total Budget % of Total Part B Budget
Alabama $32,438,471 $23,841,642 73%
Alaska $1,422,121 $837,918 59%
American Samoa $12,555 $1,593 13%
Arizona $38,177,660 $37,042,438 97%
Arkansas $9,596,226 $9,097,997 95%
California $348,282,721 $307,462,098 88%
Colorado $30,675,416 $26,912,487 88%
Connecticut $11,454,813 $8,675,379 76%
Delaware $5,792,729 $3,261,073 56%
District of Columbia $30,961,890 $16,641,260 54%
Federated States of Micronesia $50,000 $0 0%
Florida $177,239,237 $147,086,477 83%
Georgia $87,105,602 $68,378,953 79%
Guam $261,330 $61,330 23%
Hawaii $5,365,842 $2,461,232 46%
Idaho $6,859,654 $5,577,223 81%
Illinois $62,527,863 $49,520,913 79%
Indiana $38,091,297 $32,827,157 86%
Iowa $12,536,933 $2,792,070 22%
Kansas $4,191,367 $3,085,583 74%
Kentucky $8,808,198 $4,909,570 56%
Louisiana $67,353,220 $57,142,378 85%
Maine $3,820,361 $2,786,898 73%
Marshall Islands $50,796 $796 2%
Maryland $75,633,359 $50,449,501 67%
Massachusetts $37,004,042 $23,427,297 63%
Michigan $41,535,277 $23,028,005 55%
Minnesota $18,352,910 $11,405,186 62%
Mississippi $22,719,205 $17,318,585 76%
Missouri $49,191,953 $42,913,670 87%
Montana $2,609,934 $1,875,036 72%
Nebraska $7,575,029 $6,249,637 83%
Nevada $22,275,841 $18,957,465 85%
New Hampshire $4,432,691 $2,432,691 55%
New Jersey $156,472,887 $89,259,181 57%
New Mexico $6,546,878 $2,300,266 35%
New York $389,764,660 $348,971,151 90%
North Carolina $74,339,127 $61,899,332 83%
North Dakota $1,996,733 $1,541,765 77%
Northern Mariana Islands $48,923 $0 0%
Ohio $38,840,018 $21,414,782 55%
Oklahoma $20,722,523 $17,209,710 83%
Oregon $13,610,605 $10,693,980 79%
Pennsylvania $151,418,049 $131,141,250 87%
Puerto Rico $54,926,772 $48,450,680 88%
Republic of Palau $53,186 $3,186 6%
Rhode Island $6,251,610 $1,839,894 29%
South Carolina $51,018,352 $35,655,443 70%
South Dakota $897,449 $397,449 44%
Tennessee $66,355,878 $34,025,414 51%
Texas $162,276,101 $102,799,255 63%
Utah $11,216,492 $9,283,798 83%
Vermont $1,583,904 $1,477,370 93%
Virgin Islands (U.S.) $2,097,598 $1,372,598 65%
Virginia $66,149,872 $50,373,050 76%
Washington $28,467,749 $16,389,317 58%
West Virginia $12,017,397 $5,899,434 49%
Wisconsin $28,100,086 $15,407,449 55%
Wyoming $1,541,314 $991,314 64%
Total $2,611,120,706 $2,017,258,606 77%

Table 2

State / Territory Part B Base Part B Base Contribution Allocated to Part B Part B Base Contribution Allocated to ADAP % of Total Budget Part B Supplemental 1 Part B Supplemental Allocated to Part B Part B Supplemental Allocated to ADAP % of Total Budget Part B ADAP Earmark % of Total Budget Part B ADAP Supplemental 2 % of Total Budget ADAP Emergency Funding % of Total Budget Part A Contribution Allocated to Part B Part A Contribution Allocated to ADAP % of Total Budget Part B State Contribution ADAP State Contribution % of Total Budget Part B Estimated Drug Rebates ADAP Estimated Drug Rebates % of Total Budget Part B Other State or Federal ADAP Other State or Federal % of Total Budget Total FY2016 Budget
Alabama $7,622,768 $1,311,435 $6,311,333 23% $0 $0 $0 0% $8,704,238 27% $0 0% $0 0% $0 $0 0% $0 $2,419,796 7% $4,433,389 $6,406,275 33% $2,852,005 $0 9% $32,438,471
Alaska $500,000 $500,000 $0 35% $83,703 $83,703 $0 6% $540,021 38% $0 0% $297,897 21% $0 $0 0% $0 $0 0% $500 $0 0.04% $0 $0 0% $1,422,121
American Samoa $10,962 -- -- 100% $0 $0 $0 0% $1,593 13% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $12,555
Arizona $567,612 $567,612 $0 1% $0 $0 $0 0% $10,141,504 27% $0 0% $0 0% $0 $0 0% $0 $1,000,000 3% $0 $11,961,000 31% $567,610 $13,939,934 38% $38,177,660
Arkansas $3,242,703 $0 $3,242,703 34% $0 $0 $0 0% $4,207,065 44% $0 0% $0 0% $0 $0 0% $0 $0 0% $50,000 $1,200,000 13% $448,229 $448,229 9% $9,596,226
California $32,120,623 $32,120,623 $0 9% $18,700,000 $8,700,000 $10,000,000 5% $98,388,924 28% $0 0% $10,991,645 3% -- $0 -- -- $0 -- -- $177,163,243 -- -- $10,918,286 -- $348,282,721
Colorado $3,368,901 $3,368,901 $0 11% $0 $0 $0 0% $9,438,417 31% $0 0% $0 0% $0 $0 0% $0 $2,640,000 9% $0 $13,500,000 44% $394,028 $1,334,070 6% $30,675,416
Connecticut $2,779,434 -- -- 24% $0 $0 $0 0% $8,675,379 76% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $11,454,813
Delaware $2,041,656 $2,041,656 $0 35% $0 $0 $0 0% $2,571,073 44% $0 0% $0 0% $0 $0 0% $0 $0 0% $490,000 $0 8% $0 $690,000 12% $5,792,729
District of Columbia $3,855,989 $0 $3,855,989 12% $6,000,000 $6,000,000 $0 19% $12,785,271 41% $0 0% $0 0% $0 $0 0% $8,320,630 $0 27% $0 $0 0% $0 $0 0% $30,961,890
Federated States of Micronesia $50,000 -- -- 100% $0 $0 $0 0% $0 0% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $50,000
Florida $30,152,760 $30,152,760 $0 17% $0 $0 $0 0% $85,246,028 48% $0 0% $10,840,449 6% $0 $0 0% $0 $10,500,000 6% $0 $40,500,000 23% $0 $0 0% $177,239,237
Georgia $13,231,351 $13,231,351 $0 15% $2,000,000 $0 $2,000,000 2% $34,152,732 39% $8,934,091 10% $10,936,694 13% $0 $0 0% $5,495,298 $11,244,688 19% $0 $0 0% $0 $1,110,748 1% $87,105,602
Guam $200,000 -- -- 77% $0 $0 $0 0% $61,330 23% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $261,330
Hawaii $1,604,610 $1,604,610 $0 30% $0 $0 $0 0% $2,020,697 38% $0 0% $0 0% $0 $0 0% $0 $440,535 8% $1,300,000 $0 24% $0 $0 0% $5,365,842
Idaho $552,790 $552,790 $0 8% $729,641 $729,641 $0 11% $696,133 10% $182,103 3% $757,187 11% $0 $0 0% $0 $641,800 9% $0 $3,300,000 48% $0 $0 0% $6,859,654
Illinois $9,484,776 $9,484,776 $0 15% $0 $0 $0 0% $28,935,717 46% $2,669,140 4% $0 0% $0 $0 0% $3,000,000 $6,000,000 14% $522,174 $5,000,000 9% $0 $6,916,056 11% $62,527,863
Indiana $3,435,582 $1,884,089 $1,551,493 9% $0 $0 $0 0% $7,927,474 21% $2,073,766 5% $0 0% $0 $150,000 0.4% $2,780,051 $0 7% $600,000 $21,000,000 57% $0 $124,424 0% $38,091,297
Iowa $1,363,002 $1,363,002 $0 11% $6,913,714 $6,913,714 $0 55% $1,716,438 14% $132,044 1% $395,606 3% $0 $0 0% $0 $547,982 4% $1,468,147 $0 12% $0 $0 0% $12,536,933
Kansas $1,102,658 $1,102,658 $0 26% $0 $0 $0 0% $2,458,767 59% $0 0% $0 0% $0 $0 0% $0 $1,500 0.04% $0 $0 0% $3,126 $625,316 15% $4,191,367
Kentucky $3,898,628 -- -- 44% $0 $0 $0 0% $4,909,570 56% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $8,808,198
Louisiana $6,210,993 $5,210,842 $1,000,151 9% $0 $0 $0 0% $16,112,214 24% $0 0% $0 0% $0 $30,013 0.04% $0 $0 0% $5,000,000 $30,000,000 52% $0 $10,000,000 15% $67,353,220
Maine $805,151 $658,866 $146,285 21% $0 $0 $0 0% $1,013,933 27% $0 0% $0 0% $0 $0 0% $27,750 $25,000 1% $346,847 $1,601,680 51% $0 $0 0% $3,820,361
Marshall Islands $50,000 -- -- 98% $0 $0 $0 0% $796 2% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $50,796
Maryland $7,884,962 $7,884,962 $0 10% $0 $0 $0 0% $25,368,234 34% $0 0% $0 0% $0 $0 0% $0 $0 0% $17,298,896 $25,081,267 56% $0 $0 0% $75,633,359
Massachusetts $4,510,010 $4,510,010 $0 12% $0 $0 $0 0% $14,256,662 39% $0 0% $0 0% $0 $170,635 0.5% $9,066,735 $1,500,000 29% $0 $7,500,000 20% $0 $0 0% $37,004,042
Michigan $4,858,272 $4,858,272 $0 12% $0 $0 $0 0% $12,528,005 30% $0 0% $0 0% $0 $0 0% $0 $0 0% $11,250,000 $10,500,000 52% $2,399,000 $0 6% $41,535,277
Minnesota $1,974,107 $1,974,107 $0 11% $0 $0 $0 0% $5,976,071 33% $0 0% $0 0% $0 $0 0% $1,156,169 $1,063,678 12% $3,435,178 $1,961,169 29% $382,270 $2,404,268 15% $18,352,910
Mississippi $5,822,278 $0 $5,822,278 26% $5,875,000 $3,900,620 $1,974,380 26% $7,547,547 33% $1,974,380 9% $0 0% $0 $0 0% $0 $0 0% $1,500,000 $0 7% $0 $0 0% $22,719,205
Missouri $3,451,880 $3,451,880 $0 7% $0 $0 $0 0% $9,770,553 20% $0 0% $0 0% $0 $0 0% $2,645,142 $3,424,319 12% $0 $29,718,798 60% $181,261 $0 0.4% $49,191,953
Montana $500,000 $6,307 $506,307 19% $769,122 $741,205 $27,917 29% $340,898 13% $27,917 1% $688,002 26% $0 $0 0% $0 $8,995 0.3% $0 $275,000 11% $0 $0 0% $2,609,934
Nebraska $1,245,992 $1,205,992 $40,000 16% $2,585,000 $119,400 $2,465,600 34% $1,569,087 21% $125,000 2% $0 0% $0 $0 0% $0 $900,000 12% $0 $1,149,950 15% $0 $0 0% $7,575,029
Nevada $2,073,852 $1,973,852 $100,000 9% $0 $0 $0 0% $6,215,815 28% $0 0% $0 0% $0 $0 0% $0 $0 0% $0 $11,297,126 51% $1,344,524 $1,344,524 12% $22,275,841
New Hampshire $500,000 $500,000 $0 11% $0 $0 $0 0% $932,691 21% $0 0% $0 0% $0 $0 0% $0 $0 0% $1,500,000 $1,500,000 68% $0 $0 0% $4,432,691
New Jersey $10,252,658 $10,252,658 $0 7% $838,931 $838,931 $0 1% $29,697,958 19% $0 0% $4,561,223 3% $0 $0 0% $0 $0 0% $55,000,000 $55,000,000 70% $1,122,117 $0 1% $156,472,887
New Mexico $1,826,612 $1,826,612 $0 28% $0 $0 $0 0% $2,300,266 35% $0 0% $0 0% $0 $0 0% $1,660,000 $0 25% $0 $0 0% $760,000 $0 12% $6,546,878
New York $35,343,277 $34,554,721 $788,556 9% $30,000,000 $6,238,788 $23,761,212 8% $106,036,829 27% $0 0% $0 0% $0 $12,000,000 3% $0 $20,000,000 5% $0 $173,884,554 45% $0 $12,500,000 3% $389,764,660
North Carolina $11,309,795 $11,309,795 $0 15% $4,300,000 $800,000 $3,500,000 6% $22,513,611 30% $0 0% $2,672,688 4% $0 $0 0% $0 $14,341,033 19% $0 $13,872,000 19% $330,000 $5,000,000 7% $74,339,127
North Dakota $500,000 $354,968 $145,032 25% $0 $0 $0 0% $196,733 10% $0 0% $0 0% $0 $0 0% $0 $0 0% $100,000 $1,200,000 65% $0 $0 0% $1,996,733
Northern Mariana Islands $48,923 -- -- 100% $0 $0 $0 0% $0 0% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $48,923
Ohio $6,875,236 $6,875,236 $0 18% $0 $0 $0 0% $16,164,782 42% $0 0% $0 0% $0 $0 0% $2,550,000 $250,000 7% $8,000,000 $5,000,000 33% $0 $0 0% $38,840,018
Oklahoma $3,512,813 $3,512,813 $0 17% $0 $0 $0 0% $4,423,710 21% $0 0% $0 0% $0 $0 0% $0 $786,000 4% $0 $12,000,000 58% $0 $0 0% $20,722,523
Oregon $1,676,625 $1,676,625 $0 12% $0 $0 $0 0% $4,543,980 33% $0 0% $0 0% $0 $0 0% $0 $0 0% $0 $6,150,000 45% $1,240,000 $0 9% $13,610,605
Pennsylvania $10,712,140 $10,712,140 $0 7% $0 $0 $0 0% $27,281,405 18% $0 0% $0 0% $0 $0 0% $8,865,190 $10,267,000 13% $0 $80,000,000 53% $699,469 $13,592,845 9% $151,418,049
Puerto Rico $5,972,266 $5,648,311 $323,955 11% $14,349,570 $0 $14,349,570 26% $15,185,098 28% $3,972,304 7% $9,541,185 17% $0 $403,907 0.7% $0 $1,674,661 3% $61,365 $3,000,000 6% $766,416 $0 1% $54,926,772
Republic of Palau $50,000 -- -- 94% $0 $0 $0 0% $3,186 6% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $53,186
Rhode Island $1,461,037 -- -- 23% $2,950,679 -- -- 47% $1,839,894 29% $0 0% $0 0% -- -- -- -- -- -- -- -- -- -- -- -- $6,251,610
South Carolina $9,862,909 $9,862,909 $0 19% $2,000,000 $2,000,000 $0 4% $12,655,443 25% $0 0% $0 0% $0 $0 0% $0 $0 0% $3,500,000 $23,000,000 52% $0 $0 0% $51,018,352
South Dakota $500,000 $500,000 $0 56% $0 $0 $0 0% $397,449 44% $0 0% $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $897,449
Tennessee $5,130,464 $5,130,464 $0 8% $2,504,250 $0 $2,504,250 4% $13,728,317 21% $0 0% $10,592,847 16% $0 $0 0% $7,200,000 $7,200,000 22% $20,000,000 $0 30% $0 $0 0% $66,355,878
Texas $22,296,256 $22,296,256 $0 14% $2,400,000 $2,400,000 $0 1% $62,513,382 39% $16,353,019 10% $0 0% $0 $1,212,548 1% $32,404,819 $20,855,601 33% $0 $0 0% $2,375,771 $1,864,705 3% $162,276,101
Utah $1,652,047 $1,605,243 $46,804 15% $720,267 $327,451 $392,816 6% $2,080,434 19% $167,772 1% $1,322,937 12% -- $0 -- -- $0 -- -- $4,600,000 -- -- $673,035 -- $11,216,492
Vermont $500,000 $106,534 $393,466 32% $0 $0 $0 0% $393,466 25% $0 0% $0 0% -- $0 -- -- $0 -- -- $600,000 -- -- $90,438 -- $1,583,904
Virgin Islands (U.S.) $500,000 $500,000 $0 24% $0 $0 $0 0% $486,656 23% $54,180 3% $410,001 20% $0 $0 0% $225,000 $180,000 19% $0 $241,761 12% $0 $0 0% $2,097,598
Virginia $6,906,764 $6,906,764 $0 10% $2,219,875 $2,219,875 $0 3% $17,493,329 26% $4,576,120 7% $10,991,639 17% $0 $0 0% $0 $280,456 0.4% $6,650,183 $8,597,633 23% $0 $8,433,873 13% $66,149,872
Washington $3,525,055 $0 $3,525,055 12% $0 $0 $0 0% $9,564,262 34% $0 0% $0 0% $0 $0 0% $0 $0 0% $12,078,432 $3,300,000 54% $0 $0 0% $28,467,749
West Virginia $1,017,963 $1,017,963 $0 8% $0 $0 $0 0% $1,399,434 12% $0 0% $0 0% $0 $0 0% $0 $0 0% $5,100,000 $4,500,000 80% $0 $0 0% $12,017,397
Wisconsin $3,544,352 $3,443,123 $101,229 13% $2,071,000 $2,071,000 $0 7% $4,487,430 16% $0 0% $0 0% $0 $0 0% $0 $1,306,220 5% $2,898,750 $5,232,806 29% $4,279,764 $4,279,764 30% $28,100,086
Wyoming $500,000 $500,000 $0 32% $0 $0 $0 0% $223,814 15% $0 0% $0 0% $0 $0 0% $0 $367,500 24% $50,000 $400,000 29% $0 $0 0% $1,541,314
Total $306,551,494 $270,101,874 $27,900,636 12% $108,010,752 $44,084,328 $60,975,745 4% $780,821,745 30% $41,241,836 2% $75,000,000 3% $0 $13,967,103 1% $85,396,784 $119,866,764 8% $162,633,861 $801,194,262 37% $20,145,590 $96,290,515 4% $2,611,120,706

Table 3

State / Territory ADAP FY2015 Total Budget ADAP FY2016 Total Budget % Change
Alabama $33,580,145 $23,841,642 -29%
Alaska $1,252,880 $837,918 -33%
American Samoa $1,641 $1,593 -3%
Arizona $22,323,641 $37,042,438 66%
Arkansas $9,421,539 $9,097,997 -3%
California $396,334,907 $307,462,098 -22%
Colorado $26,854,321 $26,912,487 0.2%
Connecticut $25,636,087 $8,675,379 -66%
Delaware $7,531,273 $3,261,073 -57%
District of Columbia $12,946,258 $16,641,260 29%
Federated States of Micronesia $0 $0 0%
Florida $172,916,724 $147,086,477 -15%
Georgia $69,571,721 $68,378,953 -2%
Guam $65,659 $61,330 -7%
Hawaii $4,754,616 $2,461,232 -48%
Idaho $4,103,812 $5,577,223 36%
Illinois $51,025,197 $49,520,913 -3%
Indiana $38,736,256 $32,827,157 -15%
Iowa $5,353,017 $2,792,070 -48%
Kansas $2,514,880 $3,085,583 23%
Kentucky $4,926,866 $4,909,570 -0.4%
Louisiana $51,387,340 $57,142,378 11%
Maine $2,812,354 $2,786,898 -1%
Marshall Islands $0 $796 100%
Maryland $74,797,346 $50,449,501 -33%
Massachusetts $23,735,064 $23,427,297 -1%
Michigan $42,591,701 $23,028,005 -46%
Minnesota $11,195,864 $11,405,186 2%
Mississippi $11,564,057 $17,318,585 50%
Missouri $43,290,961 $42,913,670 -1%
Montana $1,331,584 $1,875,036 41%
Nebraska $4,261,893 $6,249,637 47%
Nevada $6,135,807 $18,957,465 209%
New Hampshire $3,092,073 $2,432,691 -21%
New Jersey $90,426,184 $89,259,181 -1%
New Mexico $5,410,727 $2,300,266 -57%
New York $349,500,000 $348,971,151 -0.2%
North Carolina $56,492,728 $61,899,332 10%
North Dakota $1,127,084 $1,541,765 37%
Northern Mariana Islands $1,641 $0 -100%
Ohio $25,372,174 $21,414,782 -16%
Oklahoma $13,162,698 $17,209,710 31%
Oregon $41,215,004 $10,693,980 -74%
Pennsylvania $100,200,145 $131,141,250 31%
Puerto Rico $37,199,530 $48,450,680 30%
Republic of Palau $3,283 $3,186 -3%
Rhode Island $8,081,717 $1,839,894 -77%
South Carolina $34,413,062 $35,655,443 4%
South Dakota $2,104,849 $397,449 -81%
Tennessee $53,292,735 $34,025,414 -36%
Texas $139,554,060 $102,799,255 -26%
Utah $6,880,135 $9,283,798 35%
Vermont $1,483,285 $1,477,370 -0.4%
Virgin Islands (U.S.) $1,494,334 $1,372,598 -8%
Virginia $45,943,465 $50,373,050 10%
Washington $36,870,193 $16,389,317 -56%
West Virginia $7,184,578 $5,899,434 -18%
Wisconsin $15,000,181 $15,407,449 3%
Wyoming $1,425,663 $991,314 -30%
Total $2,239,886,939 $2,017,258,606 -10%
Comparison Total 1 $2,192,921,225 $1,973,388,635 -10%

Table 4

State / Territory 2015 Part B ADAP Earmark 2016 Part B ADAP Earmark % Change 2015 Part B ADAP Supplemental 2016 Part B ADAP Supplemental 1 % Change 2015 Part B Base Contribution Allocated to ADAP 2016 Part B Base Contribution Allocated to ADAP % Change 2015 Part B Supplemental Directed to ADAP 2016 Part B Supplemental Directed to ADAP % Change 2015 ADAP Emergency Funding 2016 ADAP Emergency Funding % Change 2015 Part A Contribution Allocated to ADAP 2016 Part A Contribution Allocated to ADAP % Change 2015 State Contribution 2016 State Contribution % Change 2015 Estimated Drug Rebates 2016 Estimated Drug Rebates % Change
Alabama $10,007,209 $8,704,238 -13% $796,339 $0 -100% $7,976,597 $6,311,333 -21% $0 $0 0% $0 $0 0% $0 $0 0% $4,800,000 $2,419,796 -50% $10,000,000 $6,406,275 -36%
Alaska $543,326 $540,021 -1% $0 $0 0% $0 $0 0% $45,852 $0 -100% $643,552 $297,897 -54% $0 $0 0% $0 $0 0% $20,150 $0 -100%
American Samoa $1,641 $1,593 -3% $0 $0 0% -- -- -- -- $0 -- $0 $0 0% -- -- -- -- -- -- -- -- --
Arizona $10,827,122 $10,141,504 -6% $0 $0 0% $1,000,000 $0 -100% $0 $0 0% $0 $0 0% $0 $0 0% $1,000,000 $1,000,000 0% $9,070,000 $11,961,000 32%
Arkansas $4,038,832 $4,207,065 4% $1,193,875 $0 -100% $1,000,000 $3,242,703 224% $0 $0 0% $0 $0 0% $0 $0 0% $298,469 $0 -100% $1,900,500 $1,200,000 -37%
California $98,618,573 $98,388,924 0% $0 $0 0% $0 $0 0% $10,000,000 $10,000,000 0% $6,441,447 $10,991,645 71% $0 $0 0% $18,191,000 $0 -100% $263,083,887 $177,163,243 -33%
Colorado $9,576,324 $9,438,417 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $3,214,455 $2,640,000 -18% $10,000,000 $13,500,000 35%
Connecticut $8,886,087 $8,675,379 -2% $0 $0 0% $0 -- -- $0 $0 -- $0 $0 0% $0 -- -- $0 -- -- $16,750,000 -- --
Delaware $2,631,273 $2,571,073 -2% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $4,900,000 $0 -100%
District of Columbia $12,946,258 $12,785,271 -1% $0 $0 0% $0 $3,855,989 100% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0%
Federated States of Micronesia $0 $0 0% $0 $0 0% $0 -- -- $0 $0 -- $0 $0 0% $0 -- -- $0 -- -- $0 -- --
Florida $85,677,240 $85,246,028 -1% $0 $0 0% $3,784,727 $0 -100% $4,000,000 $0 -100% $8,954,757 $10,840,449 21% $0 $0 0% $10,500,000 $10,500,000 0% $60,000,000 $40,500,000 -33%
Georgia $32,093,981 $34,152,732 6% $9,486,948 $8,934,091 -6% $0 $0 0% $6,106,950 $2,000,000 -67% $10,262,288 $10,936,694 7% $0 $0 0% $11,555,118 $11,244,688 -3% $0 $0 0%
Guam $65,659 $61,330 -7% $0 $0 0% -- -- -- -- $0 -- $0 $0 0% -- -- -- -- -- -- -- -- --
Hawaii $2,014,081 $2,020,697 0.3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $440,535 $440,535 0% $2,300,000 $0 -100%
Idaho $729,632 $696,133 -5% $215,678 $182,103 -16% $0 $0 0% $0 $0 0% $486,702 $757,187 56% $0 $0 0% $681,800 $641,800 -6% $1,990,000 $3,300,000 66%
Illinois $28,691,218 $28,935,717 1% $2,669,140 $2,669,140 0% $0 $0 0% $0 $0 0% $4,664,839 $0 -100% $0 $0 0% $11,000,000 $6,000,000 -45% $4,000,000 $5,000,000 25%
Indiana $7,916,800 $7,927,474 0.1% $2,340,198 $2,073,766 -11% $1,819,454 $1,551,493 -15% $0 $0 0% $0 $0 0% $176,400 $150,000 -15% $0 $0 0% $26,483,404 $21,000,000 -21%
Iowa $1,710,410 $1,716,438 0.4% $132,044 $132,044 0% $0 $0 0% $0 $0 0% $134,158 $395,606 195% $0 $0 0% $547,982 $547,982 0% $2,828,423 $0 -100%
Kansas $2,504,880 $2,458,767 -2% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $10,000 $1,500 -85% $0 $0 0%
Kentucky $4,926,866 $4,909,570 -0.4% $0 $0 0% -- -- -- -- $0 -- $0 $0 0% -- -- -- -- -- -- -- -- --
Louisiana $16,083,103 $16,112,214 0.2% $1,282,605 $0 -100% $1,532,132 $1,000,151 -35% $0 $0 0% $6,625,015 $0 -100% $864,485 $30,013 -97% $0 $0 0% $25,000,000 $30,000,000 20%
Maine $1,016,069 $1,013,933 -0.2% $0 $0 0% $246,285 $146,285 -41% $0 $0 0% $0 $0 0% $0 $0 0% $50,000 $25,000 -50% $1,500,000 $1,601,680 7%
Marshall Islands $0 $796 100% $0 $0 0% -- -- -- -- $0 -- $0 $0 0% -- -- -- -- -- -- -- -- --
Maryland $25,372,991 $25,368,234 -0.02% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $49,374,355 $25,081,267 -49%
Massachusetts $14,171,054 $14,256,662 1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $170,635 $170,635 0% $1,893,375 $1,500,000 -21% $7,500,000 $7,500,000 0%
Michigan $12,591,701 $12,528,005 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $30,000,000 $10,500,000 -65%
Minnesota $5,990,537 $5,976,071 -0.2% $0 $0 0% $0 $0 0% $451,098 $0 -100% $0 $0 0% $0 $0 0% $1,063,678 $1,063,678 0% $1,742,749 $1,961,169 13%
Mississippi $7,444,057 $7,547,547 1% $0 $1,974,380 100% $370,000 $5,822,278 1474% $0 $1,974,380 100% $0 $0 0% $0 $0 0% $1,750,000 $0 -100% $0 $0 0%
Missouri $9,866,043 $9,770,553 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $3,566,808 $3,424,319 -4% $29,858,110 $29,718,798 -0.5%
Montana $363,585 $340,898 -6% $27,917 $27,917 0% $114,582 $506,307 342% $0 $27,917 100% $54,410 $688,002 1164% $0 $0 0% $137,090 $8,995 -93% $634,000 $275,000 -57%
Nebraska $1,561,036 $1,569,087 1% $125,000 $125,000 0% $50,857 $40,000 -21% $125,000 $2,465,600 1872% $0 $0 0% $0 $0 0% $900,000 $900,000 0% $1,500,000 $1,149,950 -23%
Nevada $6,135,807 $6,215,815 1% $0 $0 0% -- $100,000 -- -- $0 -- $0 $0 0% -- $0 -- -- $0 -- -- $11,297,126 --
New Hampshire $943,844 $932,691 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $2,148,229 $1,500,000 -30%
New Jersey $30,166,077 $29,697,958 -2% $0 $0 0% $0 $0 0% $0 $0 0% $5,260,107 $4,561,223 -13% $0 $0 0% $0 $0 0% $55,000,000 $55,000,000 0%
New Mexico $2,289,027 $2,300,266 0.5% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $900,000 $0 -100% $0 $0 0%
New York $107,791,915 $106,036,829 -2% $0 $0 0% $1,039,594 $788,556 -24% $0 $23,761,212 100% $0 $0 0% $8,915,740 $12,000,000 35% $28,000,000 $20,000,000 -29% $187,252,751 $173,884,554 -7%
North Carolina $22,508,629 $22,513,611 0.02% $0 $0 0% $0 $0 0% $0 $3,500,000 100% $2,691,965 $2,672,688 -1% $0 $0 0% $14,336,118 $14,341,033 0.03% $11,866,577 $13,872,000 17%
North Dakota $177,279 $196,733 11% $52,404 $0 -100% $97,401 $145,032 49% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $800,000 $1,200,000 50%
Northern Mariana Islands $1,641 $0 -100% $0 $0 0% -- -- -- -- $0 -- $0 $0 0% -- -- -- -- -- -- -- -- --
Ohio $15,872,174 $16,164,782 2% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $2,500,000 $250,000 -90% $7,000,000 $5,000,000 -29%
Oklahoma $4,473,000 $4,423,710 -1% $0 $0 0% $903,698 $0 -100% $0 $0 0% $0 $0 0% $0 $0 0% $786,000 $786,000 0% $6,000,000 $12,000,000 100%
Oregon $4,588,724 $4,543,980 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $6,058,280 $6,150,000 2%
Pennsylvania $27,514,285 $27,281,405 -1% $0 $0 0% $100,000 $0 -100% $0 $0 0% $0 $0 0% $0 $0 0% $10,267,000 $10,267,000 0% $62,315,563 $80,000,000 28%
Puerto Rico $15,434,723 $15,185,098 -2% $4,562,488 $3,972,304 -13% $80,763 $323,955 301% $1,923,247 $14,349,570 87% $9,558,425 $9,541,185 0% $0 $403,907 100% $1,654,127 $1,674,661 1% $3,985,438 $3,000,000 -25%
Republic of Palau $3,283 $3,186 -3% $0 $0 0% -- -- -- -- $0 -- $0 $0 0% -- -- -- -- -- -- -- -- --
Rhode Island $1,802,332 $1,839,894 2% $0 $0 0% $1,137,973 -- -- $0 -- -- $357,275 $0 -100% $0 -- -- $0 -- -- $4,602,008 -- --
South Carolina $12,754,206 $12,655,443 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $5,658,856 $0 -100% $16,000,000 $23,000,000 44%
South Dakota $389,849 $397,449 2% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $1,715,000 $0 -100%
Tennessee $14,127,294 $13,728,317 -3% $0 $0 0% $0 $0 0% $0 $2,504,250 100% $7,423,368 $10,592,847 43% $702,134 $0 -100% $7,000,000 $7,200,000 3% $15,000,000 $0 -100%
Texas $61,591,981 $62,513,382 1% $18,206,525 $16,353,019 -10% $0 $0 100% $0 $0 0% $0 $0 0% $153,221 $1,212,548 691% $35,102,333 $20,855,601 -41% $24,500,000 $0 -100%
Utah $2,110,928 $2,080,434 -1% $167,772 $167,772 0% $721,354 $46,804 -94% $204,193 $392,816 92% $838,539 $1,322,937 58% $0 $0 0% $0 $0 0% $2,800,000 $4,600,000 64%
Vermont $372,613 $393,466 6% $0 $0 0% $0 $393,466 100% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $750,000 $600,000 -20%
Virgin Islands (U.S.) $492,440 $486,656 -1% $54,180 $54,180 0% $0 $0 0% $0 $0 0% $447,714 $410,001 -8% $0 $0 0% $180,000 $180,000 0% $320,000 $241,761 -24%
Virginia $17,988,026 $17,493,329 -3% $0 $4,576,120 100% $0 $0 0% $0 $0 0% $10,155,439 $10,991,639 8% $0 $0 0% $2,800,000 $280,456 -90% $15,000,000 $8,597,633 -43%
Washington $9,653,473 $9,564,262 -1% $0 $0 0% $3,568,711 $3,525,055 -1% $0 $0 0% $0 $0 0% $0 $0 0% $6,611,092 $0 -100% $17,036,917 $3,300,000 -81%
West Virginia $1,384,578 $1,399,434 1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $5,800,000 $4,500,000 -22%
Wisconsin $4,518,961 $4,487,430 -1% $0 $0 0% $0 $101,229 100% $0 $0 0% $0 $0 0% $0 $0 0% $1,306,220 $1,306,220 0% $9,175,000 $5,232,806 -43%
Wyoming $225,702 $223,814 -1% $0 $0 0% $86,061 $0 -100% $0 $0 0% $0 $0 0% $0 $0 0% $367,500 $367,500 0% $746,400 $400,000 -46%
Total $784,180,379 $780,821,745 -0.4% $41,313,113 $41,241,836 -0.2% $25,630,189 $27,900,636 9% $22,856,340 $60,975,745 167% $75,000,000 $75,000,000 0% $10,982,615 $13,967,103 27% $189,069,556 $119,866,764 -37% $1,016,307,741 $801,194,262 -21%

Section Two

What Does it Take to Achieve Viral Suppression?

The Ryan White Program, including ADAP, plays a critical role in efforts to end the HIV epidemic nationally by having a measurable impact on multiple “bars” within the HIV care continuum, most notably linkage to and retention in care and treatment as well as viral load suppression. ADAPs work to reduce new HIV infections, increase access to care and improve health outcomes, and reduce HIV-related disparities and health inequities1 by ensuring continuous access to life-saving treatment and care for eligible PLWH. ADAPs’ support of insurance and direct provision of ARV therapy and other medications to PLWH is necessary in order for clients to achieve optimal health outcomes and viral load suppression.

There is now conclusive scientific evidence that a person living with HIV who is on antiretroviral therapy (ART) and is durably virally suppressed (defined as having a consistent viral load of less than <200 copies/mL) does not sexually transmit HIV. Viral load suppression in turn greatly reduces HIV transmission and rates for new infections. In addition to viral load suppression, improved access to care and treatment is associated with elevations in CD4 count and reductions in PLWH’s progression to CDC-defined Stage 3 HIV-infection or AIDS2. The National HIV/AIDS Strategy for The United States: Updated to 2020 emphasizes the need for “seamless systems…” such as ADAP, “…to link people to care immediately after diagnosis and support retention in care to achieve viral suppression that can maximize the benefits of early treatment and reduce transmission risk3.”

Chart 2

Engagement in Ryan White Part B and ADAP, Calendar Year 2015

Engagement in Ryan White Part B and ADAP, Calendar Year 2015

Achieving Viral Suppression

Chart 3

Ryan White Part B Clients Served, by Viral Load, Calendar Year 2015

Ryan White Part B Clients Served, by Viral Load, Calendar Year 2015

Chart 4

ADAP Clients Served by Program, by Viral Load, Calendar Year 2015

ADAP Clients Served by Program, by Viral Load, Calendar Year 2015

Chart 5

Ryan White Part B/ADAP Provision of Services for Incarcerated Individuals, Calendar Year 2015

Ryan White Part B/ADAP Provision of Services for Incarcerated Individuals, Calendar Year 2015

The majority (77%) of all clients served by ADAPs in calendar year (CY) 2015 were reported as virally suppressed, defined as having a viral load that is less than or equal to 200 copies/mL. Data related to viral load suppression were calculated based on the most recent viral load recorded for each client as of December 31, 2015, among those served by the ADAP program in CY2015, (including those clients not on ARV medications, such as those who were enrolled but who may not have received medications). According to the 2015 Ryan White Program client-level data report, 83% of people receiving any service within the Ryan White Program are estimated to be virally suppressed4. In contrast, while not all individuals may be receiving a service related to HIV, an unpublished report indicates that 55% of all PLWH nationally are stimated to be virally suppressed5.

Overall, nearly 98% of Part B and ADAP budgets are allocated to program services; only 2.2% of Part B and ADAP funding is used to administer the program. ADAP programs bridge client access to medications and comprehensive care. In addition to medication access, which provides a clear benefit to clients, Part B programs have continued to focus on the whole person – what does a client need to best benefit from medication access? While all of the core medical and support services6 are integral to the care and treatment of PLWH, each of the following categories provide services related to challenges PLWH face in reaching a positive health outcome, including improving treatment adherence, thus leading to the achievement of viral load suppression:

  • Mental Health Services: Mental health has a direct impact on physical health, and the way individuals make choices. Treatment for mental health conditions, including depression, can improve individuals’ adherence to medications and overall health outcomes. During CY2015, 36 jurisdictions served one or more Part B program client via Mental Health Services.
  • Substance Use Services (Outpatient and Residential Care): Substance use disproportionately impacts PLWH, posing challenges in terms of the overall effectiveness of their HIV care and treatment as well as their broader health. In addition to deleterious effects on HIV-specific health outcomes, they must also contend with risks of overdose and death from overdose, a common cause of non-AIDS-related death among PLWH. Yet individuals with substance use disorders may not seek treatment for these issues because of inadequate screening, stigma, or a lack of available and adequate services. During CY2015, 18 jurisdictions served one or more Part B program client via Substance Use Services (Outpatient and Residential Care).
  • Case Management (non-medical):Over the course of time, most ADAPs require clients to participate in case management to enroll in and be served by ADAP. Case management is an overall form of navigation support for clients to be connected to Ryan White Program and non-Ryan White Program services. Case management assists clients in coordinating care and other related services, assisting clients in accessing all services necessary to ensure they are able to adhere to medications. During CY2015, 29 jurisdictions served one or more Part B program client via Case Management (non-medical).
  • Food Bank/Home-Delivered Meals; Housing Services; and Medical Transportation Services: While it has long been experienced anecdotally, the link between insecure food, housing, and transportation services and medication adherence is now being fully researched. Comprehensive access to these service categories has been shown to increase clients’ adherence to medications and overall health outcomes. During CY2015, 28 jurisdictions served one or more Part B program client via Food Bank/Home-Delivered Meals; 22 via Housing Services; and 35 via Medical Transportation Services.
  • Provision of ADAP/Ryan White Part B Services for Recently Incarcerated: It is acutely important for HIV public health programs to evaluate the structural interventions that could be enacted to address recidivism among PLWH. The potential for re-incarceration is a clear indicator of poor health outcomes among PLWH. Ideally immediately, but within the six months directly following release, PLWH should be enrolled in insurance or provided other access to health care and the services associated with addressing the whole health of the individual. During CY2015, 22 jurisdictions provided Part B or ADAP services for recently incarcerated individuals. Seventeen jurisdictions provided Part B or ADAP services for currently incarcerated individuals.

1 https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/

2 The AIDS case definition used as part of the National ADAP Monitoring Survey may be found here and is consistent with the most recent ADAP Data Report (ADR) submission. The ADR is the reporting system through which ADAP grantees must submit quarterly reports to HRSA as part of the funding requirements. More information on the ADR may be found here. CDC released an updated case definition in April 2014 (located here).

3 https://www.aids.gov/federal-resources/national-hiv-aids-strategy/overview/

4 The 2014 Ryan White Program client-level data report estimate of client viral suppression is based on the totality of services provided by clients. ADAPs only maintain a subset of the data for an individual client, which is reflected in the difference in viral suppression rates represented in this data.

5 Rates for viral load suppression across the Ryan White program are available here.

6 More information and definitions of core medical and support service categories are available here.

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Chart 6

Top Ryan White Part B/ADAP Services Provided to Incarcerated Individuals, Calendar Year 2015

Top Ryan White Part B/ADAP Services Provided to Incarcerated Individuals, Calendar Year 2015

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Chart 7

Top Ryan White Part B Services Provided to Recently Incarcerated, Calendar Year 2015

Top Ryan White Part B Services Provided to Recently Incarcerated, Calendar Year 2015

Chart 8

Ryan White Part B Clients Served and Top Ten States, by Clients Served, Calendar Year 2015

Ryan White Part B Clients Served and Top Ten States, by Clients Served, Calendar Year 2015

Chart 9

ADAP Clients Served and Top Ten States, by Clients Served, Calendar Year 2015

ADAP Clients Served and Top Ten States, by Clients Served, Calendar Year 2015

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Chart 10

ADAP Clients by Viral Load, by Risk Category (Men Who Have Sex With Men), Race, and Income, Enrolled During 12-Month Period, Calendar Year 2015

ADAP Clients by Viral Load, by Risk Category (Men Who Have Sex With Men), Race, and Income, Enrolled During 12-Month Period, Calendar Year 2015

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Chart 11

ADAP Viral Load Suppression Rate, Clients Served Calendar Year 2015

ADAP Viral Load Suppression Rate, Clients Served Calendar Year 2015

Table 5

State / Territory Part B Core Medical Services
  AIDS Drug Assistance Program Treatments Early Intervention Services (EIS) for Part B Health Insurance Premium and Cost-Sharing Assistance for Low-Income Individuals Home Health Care Home and Community-Based Health Services Hospice Services Local AIDS Pharmaceutical Assistance Medical Case Management Medical Nutrition Therapy Mental Health Services Outpatient and Ambulatory Health Services Oral Health Care Substance Use Services (Outpatient Care) Total Expenditures
  Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures
Alabama 0 $0 4,092 $285,947 81 $75,925 0 $0 0 $0 0 $0 63 $127,738 4,466 $1,087,626 118 $17,928 344 $200,660 3,074 $2,354,766 1,075 $1,114,386 280 $79,660 $5,344,636
Alaska 137 $1,003,273 0 $0 67 $41,544 0 $0 0 $0 0 $0 0 $0 239 $177,897 158 $1,754 3 $725 39 $31,916 29 $30,390 26 $9,525 $1,297,024
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 0 $0 508 $98,543 218 $35,749 0 $0 0 $0 0 $0 0 $0 2,096 $305,759 0 $0 400 $83,174 1,712 $296,900 940 $475,471 98 $9,503 $1,305,099
Arkansas 495 $4,827,467 0 $0 300 $343,280 200 $15,763 0 $0 0 $0 0 $0 1,515 $412,529 125 $20,288 300 $11,682 1,515 $412,529 950 $1,121,068 0 $0 $7,164,606
California -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Colorado 0 $0 96 $232,853 0 $0 0 $0 0 $0 0 $0 0 $0 486 $254,520 44 $5,611 141 $72,777 4 $6,251 322 $220,767 1,040 $49,800 $842,579
Connecticut -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Delaware 1,284 $1,826,782 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 1,063 $327,557 0 $0 0 $0 0 $0 0 $0 0 $0 $2,154,339
District of Columbia 1,140 $15,282,018 140 $212,769 0 $0 0 $0 0 $0 0 $0 0 $0 474 $1,182,130 177 $77,353 56 $129,288 0 $0 0 $0 0 $0 $16,883,558
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 0 $0 0 $0 1,632 $1,142,345 4 $43,314 15 $7,984 0 $0 2,350 $3,864,151 10,018 $3,269,517 539 $86,712 373 $154,680 7,793 $3,864,151 2,711 $1,254,588 38 $34,842 $13,722,284
Georgia 8,951 $47,001,899 0 $0 28 $6,837 3 $2,819 0 $0 0 $0 0 $0 9,952 $1,005,774 847 $61,962 248 $43,762 9,798 $3,221,917 958 $289,842 0 $0 $51,634,812
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 0 $0 0 $0 56 $43,709 0 $0 0 $0 0 $0 0 $0 801 $418,561 72 $28,905 40 $14,812 635 $420,720 241 $195,959 0 $0 $1,122,666
Idaho 233 $3,802,696 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 253 $268,156 0 $0 0 $0 141 $47,573 0 $0 0 $0 $4,118,425
Illinois 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 4,312 $4,315,310 1 $190 140 $138,647 1,001 $647,516 593 $722,274 11 $27,739 $5,851,676
Indiana 1,034 $10,762,478 0 $0 1,822 $18,007,367 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 806 $1,392,041 7 $2,694 7 $1,029 $30,165,609
Iowa 459 $1,530,863 0 $7,658 28 $11,593 0 $0 0 $0 0 $0 0 $0 379 $332,132 0 $0 98 $52,770 0 $0 14 $4,618 18 $9,754 $1,949,388
Kansas 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 1,140 $0 0 $0 0 $0 146 $25,153 272 $124,563 0 $0 $149,716
Kentucky -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Louisiana 6,392 $17,659,107 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 121 $138,241 0 $0 356 $248,013 51 $27,643 $18,073,004
Maine 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 87 $137,615 0 $0 0 $0 0 $0 183 $159,830 0 $0 $297,445
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 42 $328,155 15 $16,209 157 $272,051 841 $1,202,332 594 $498,706 21 $104,768 $2,422,221
Massachusetts 5,425 $4,723,078 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 1,881 $3,208,503 0 $0 0 $0 0 $0 0 $0 0 $0 $7,931,581
Michigan 3,542 $11,636,854 193 $255,121 182 $81,509 0 $0 0 $0 0 $0 0 $0 2,040 $2,193,858 19 $6,278 172 $93,827 465 $590,174 1,085 $403,642 2 $34,172 $15,295,435
Minnesota 1,577 $4,264,883 0 $0 1,101 $822,194 0 $0 0 $0 0 $0 0 $0 513 $327,158 61 $5,129 130 $46,421 0 $0 605 $93,283 0 $0 $5,559,068
Mississippi 2,277 $7,226,160 21 $994,437 0 $0 0 $0 8 $35,813 0 $0 0 $0 1,052 $864,771 111 $17,760 44 $38,850 883 $1,481,444 606 $316,120 0 $0 $10,975,355
Missouri 0 $0 0 $0 0 $0 1 $65 0 $0 0 $0 0 $0 7,056 $358,166 0 $0 9 $1,640 201 $76,245 1,816 $133,904 0 $0 $570,020
Montana 304 $35,793 119 $79,780 0 $168,050 0 $0 0 $0 0 $0 0 $0 -- $168,050 0 $0 0 $0 272 -- 5 -- 0 $0 $451,673
Nebraska 728 $1,766,038 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 474 $463,944 0 $0 11 $18,713 0 $0 0 $0 0 $0 $2,248,695
Nevada 0 $0 16 $51,998 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 96 $10,986 168 $153,474 96 $40,656 0 $0 $257,114
New Hampshire 432 $154,442 0 $0 74 $365,844 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $520,286
New Jersey 0 $0 0 $0 0 $0 0 $0 15 $134,437 0 $0 0 $0 3,304 $1,597,247 330 $72,637 489 $191,991 2,030 $3,720,671 816 $533,002 0 $0 $6,249,985
New Mexico 474 $3,049,474 0 -- 534 -- 0 -- 0 -- 0 -- 0 -- 1,499 -- 29 -- 213 -- 308 -- 225 $260,543 5 -- $3,310,017
New York 22,916 -- 0 $0 0 $0 255 -- 0 $0 0 $0 0 $0 2,911 -- 0 $0 1,541 -- 16,248 -- 3,054 -- 0 $0 --
North Carolina 0 $0 0 $0 279 $114,048 0 $0 2 $188 0 $0 0 $0 4,511 $2,026,518 159 $23,584 513 $122,301 4,718 $3,119,582 899 $548,718 163 $126,989 $6,081,928
North Dakota 44 $830,079 0 $0 134 $207,798 0 $0 0 $0 0 $0 0 $0 29 $3,306 2 $476 0 $0 83 $96,043 18 $14,160 0 $0 $1,151,862
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 74 $63,840 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 48 $13,281 2,040 $898,838 1,096 $820,894 0 $0 $1,796,853
Oklahoma 0 $0 21 $5,775 0 $0 10 $4,935 0 $0 0 $0 0 $0 928 $450,040 0 $0 365 $143,832 892 $390,051 983 $542,580 0 $0 $1,537,213
Oregon -- $17,499,001 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 1,060 -- 16 $13,694 3 $5,240 0 $0 219 $90,123 0 $0 $17,608,058
Pennsylvania 8,460 $90,714,193 0 $0 363 $73,955 90 $61,885 2 $979 3 $42,051 0 $0 8,282 $4,236,906 797 $29,757 343 $37,615 7,149 $888,120 816 $244,274 200 $53,869 $96,383,604
Puerto Rico 7,988 $60,946,948 0 $0 0 $0 14 $170,720 290 $525,546 0 $0 0 $0 4,414 $603,913 937 $348,774 1,689 $282,301 4,461 $305,385 135 $194,236 0 $0 $63,377,823
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
South Carolina 0 $0 0 $0 0 $0 1 $366 0 $0 0 $0 225 $3,747 7,772 $2,479 240 $20,970 789 $263,376 6,397 $3,719,777 873 $412,816 548 $108,500 $4,532,031
South Dakota 0 $0 0 $0 130 $554,244 1 $1,256 0 $0 0 $0 0 $0 286 $79,088 0 $0 4 $4,893 106 $55,974 77 $263,699 0 $0 $959,154
Tennessee 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 6,128 $1,838,366 52 $5,028 445 $79,542 4,942 $736,795 1,579 $1,614,569 0 $0 $4,274,300
Texas -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Utah -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Vermont -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Virgin Islands (U.S.) 94 $33,272 150 $63,537 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $96,809
Virginia 3,200 -- 0 $0 425 $86,618 0 $0 0 $0 0 $0 0 $0 2,577 $858,222 1 $2,504 376 $144,931 1,306 $182,913 1,651 $12,816,111 77 $59,813 $14,151,112
Washington 3,206 $6,637,981 0 $0 2,064 $7,477,633 0 $0 0 $0 0 $0 0 $0 5,376 $5,488,191 23 $2,168 128 $25,142 2,007 $580,974 491 $384,500 0 $0 $20,596,589
West Virginia 607 $3,821,409 0 $0 412 $86,060 0 $0 2 $1,024 0 $0 0 $0 1,108 $404,773 0 $0 4 $1,530 0 $0 258 $301,265 4 $7,695 $4,623,756
Wisconsin 0 $0 311 $191,000 0 $0 0 $0 0 $0 0 $0 0 $0 2,094 $999,087 0 $0 703 $331,826 3,078 $522,188 1,384 $318,261 91 $57,723 $2,420,085
Wyoming 0 $0 0 $0 86 $236,155 0 $0 0 $0 0 $0 0 $0 140 $15,988 0 $0 4 $1,966 67 $11,831 17 $12,686 0 $0 $278,626
Total 81,473 $317,100,028 5,667 $2,479,418 10,016 $29,982,457 579 $301,123 334 $705,971 3 $42,051 2,638 $3,995,636 102,758 $40,011,812 4,873 $865,671 10,540 $3,173,473 85,326 $31,454,244 28,049 $26,823,211 2,680 $803,024 $457,738,119

Table 6

State / Territory Part B Support Services
  Case Management (Non-Medical) Child Care Services Emergency Financial Assistance Food Bank/Home-Delivered Meals Health Education/Risk Reduction Housing Services Legal Services Linguistic Services Medical Transportation Services Outreach Services Psychosocial Support Services Referral for Health Care/Support Services Rehabilitation Services Respite Care Substance Use Services (Residential) Treatment Adherence Counseling Total Expenditures
  Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures
Alabama 2,765 $782,052 0 $0 595 $329,588 1,500 $285,723 349 $42,662 0 $0 99 $37,460 38 $6,257 647 $187,393 0 $0 78 $17,378 81 $8,866 0 $0 0 $0 0 $0 14 $166 $1,697,545
Alaska 184 $114,586 0 $0 4 $1,470 23 $4,234 0 $0 0 $0 0 $0 2 $106 62 $5,598 4 $2,940 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $128,934
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 1,228 $145,863 0 0 116 $15,523 176 $36,452 0 $0 30 $161,910 0 $0 0 $0 122 $6,456 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $366,204
Arkansas 1,515 $474,399 0 $0 0 $0 975 $81,775 250 $2,275 300 $500,000 0 $0 150 $12,815 1,200 $72,754 195 $3,517 100 $65,589 0 $0 0 $0 0 $0 0 $0 0 $0 $1,213,124
California -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Colorado 2,216 $946,246 0 $0 108 $23,635 183 $40,004 227 $262,061 7 $4,090 0 $0 0 $0 517 $42,419 400 $113,385 43 $4,507 287 $107,382 0 $0 0 $0 0 $0 1 $72 $1,543,801
Connecticut -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Delaware 936 $250,000 0 $0 223 $136,860 0 $0 0 $0 85 $250,087 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $636,947
District of Columbia 0 $0 0 $0 0 $0 740 $529,933 0 $0 0 $0 0 $0 0 $0 182 $4,070 110 $173,999 62 $45,470 0 $0 0 $0 0 $0 0 $0 30 $143,538 $897,010
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 13,826 $2,314,127 0 $0 32 $19,025 1,890 $141,103 0 $0 0 $0 0 $0 14 $3,622 2,262 $309,929 339 $534,129 56 $18,438 10,046 $1,212,676 0 $0 0 $0 28 $106,026 0 $0 $4,659,075
Georgia 6,199 $1,082,065 0 $0 975 $270,236 485 $24,548 2,241 $42,335 16 $4,733 0 $0 71 $14,088 1,850 $128,885 0 $0 152 $32,218 0 $0 0 $0 0 $0 0 $0 109 $5,543 $1,604,651
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 0 $0 0 $0 316 $137,408 687 $245,838 0 $0 111 $224,671 0 $0 0 $0 13 $9,100 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $617,017
Idaho 0 $0 0 $0 18 $3,750 0 $0 0 $0 0 $0 0 $0 0 $0 141 $7,651 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $11,401
Illinois 0 $0 0 $0 146 $50,384 1,250 $238,431 0 $0 87 $134,138 96 $61,180 5 $1,486 660 $40,550 48 $18,443 16 $61,437 0 $0 0 $0 0 $0 0 $0 377 $89,970 $696,019
Indiana 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $0
Iowa 392 $238,994 0 $0 43 $19,333 118 $11,864 0 $0 204 $249,569 0 $0 24 $2,194 379 $34,302 113 $39,016 594 $340,081 188 $36,121 0 $0 0 $0 0 $0 0 $0 $971,474
Kansas 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $0
Kentucky -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Louisiana 2,505 $1,327,218 0 $0 219 $46,381 1,389 $253,979 0 $0 0 $0 0 $0 0 $0 1,412 $333,174 0 $0 88 $29,745 0 $0 0 $0 0 $0 0 $0 0 $0 $1,990,497
Maine 0 $0 0 0 0 $0 497 $154,200 0 $0 168 $78,557 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $232,757
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 82 $383,541 0 $0 343 $273,856 0 $0 0 $0 32 $50,703 0 $0 26 $10,693 100 $16,069 54 $228,195 240 $175,497 0 $0 0 $0 0 $0 0 $0 36 $291,750 $1,430,304
Massachusetts 0 $0 0 $0 0 $0 95 $31,834 0 $0 0 $0 60 $100,000 0 $0 874 $58,465 0 $0 192 $139,883 0 $0 0 $0 0 $0 0 $0 0 $0 $330,182
Michigan 649 $253,628 0 $0 191 $57,084 308 $22,942 130 $15,324 1 $6,154 0 $0 14 $1,232 753 $93,374 -- $2,089 113 $10,899 0 $0 1 $125 0 $0 0 $0 12 $71,025 $533,876
Minnesota 517 $108,300 0 $0 823 $291,354 1,143 $99,858 0 $0 0 $0 35 $4,823 12 $2,941 1,224 $347,931 0 $0 0 $0 2,539 $128,226 0 $0 0 $0 0 $0 0 $0 $983,433
Mississippi 396 $413,403 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 186 $31,000 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $444,403
Missouri 125 $130,000 0 $0 178 $829,982 0 $0 0 $0 215 $75,266 0 $0 0 $0 475 $113,330 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $1,148,578
Montana 0 $0 0 $0 -- $83,950 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $83,950
Nebraska 0 $0 0 $0 740 $32,033 0 $0 0 $0 46 $56,098 0 $0 0 $0 0 $0 81 $65,108 62 $14,262 0 $0 0 $0 0 $0 0 $0 0 $0 $167,501
Nevada 14 $28,499 0 $0 0 $0 0 $0 133 $163,964 20 $85,334 7 $16,202 0 $0 0 $0 289 $185,660 4 $68,351 0 $0 0 $0 0 $0 0 $0 1,056 $80,981 $628,991
New Hampshire 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $0
New Jersey 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 136 $90,000 0 $0 473 $108,971 232 $474,684 212 $30,225 0 $0 0 $0 0 $0 0 $0 0 $0 $703,880
New Mexico 1,336 -- 0 -- 85 -- 270 -- 0 -- 98 -- 0 -- 0 -- 436 -- 0 -- 61 -- 0 -- 0 -- 0 -- 0 -- 0 -- --
New York 3,821 -- 0 -- 0 $0 798 -- 3,017 -- 0 $0 0 $0 0 $0 0 $0 0 $0 1,047 -- 0 $0 0 $0 0 $0 0 $0 624 -- --
North Carolina 728 $23,857 0 $0 607 $119,812 429 $25,244 798 $60,468 0 $0 0 $0 1 $70 788 $87,698 604 -- 228 $26,859 1,702 $201,123 0 $0 0 $0 0 $0 1,170 $91,383 $636,514
North Dakota 170 $36,793 0 $0 40 $33,408 0 $0 0 $0 1 $20 0 $0 0 $0 21 $3,055 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $73,276
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 643 $16,271 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $16,271
Oklahoma 1,041 $418,090 0 $0 201 $107,197 0 $0 0 $0 0 $0 0 $0 0 $0 342 $57,784 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $583,071
Oregon 1,047 -- 0 $0 659 $227,910 0 $0 0 $0 193 $99,274 0 $0 46 $4,317 401 $55,468 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 14 $458 $387,427
Pennsylvania 0 $0 0 $596,812 602 $562,000 1,617 $455,723 2,697 $327,735 1,135 $145,463 977 $32,747 54 $238,656 2,442 $20,606 1,131 $107,368 312 $107,368 0 $0 0 $0 60 $36,922 0 $0 5,747 $81,703 $2,713,103
Puerto Rico 2,719 $493,080 0 $0 1,309 $332,525 17 $40,040 0 $0 8 $46,148 0 $0 0 $0 920 $618,638 745 $156,976 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $1,687,407
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
South Carolina 2,321 $217,689 0 $0 998 $116,354 1,015 $34,497 4,917 $201,195 0 $0 0 $0 78 $2,816 2,266 $178,249 94 $31,453 2,445 $70,864 1,766 $113,081 0 $0 0 $0 0 $0 524 $65,512 $1,031,710
South Dakota 225 $46,533 0 $0 150 $206,171 116 $31,000 0 $0 0 $0 0 $0 1 $53 90 $18,510 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $302,267
Tennessee 1,375 $480,735 0 $0 17 $2,808 1,519 $144,123 0 $0 0 $0 0 $0 0 $0 956 $78,839 0 $0 178 $33,015 1,396 $45,174 0 $0 0 $0 0 $0 0 $0 $784,694
Texas -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Utah -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Vermont -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Virgin Islands (U.S.) 7 $10,935 18 $10,935 20 $2,700 3 $3,976 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $28,546
Virginia 2,872 $318,428 0 $0 294 $95,316 242 $25,806 90 $8,308 0 $0 0 $0 0 $0 825 $225,150 237 $11,378 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $684,386
Washington 0 $0 0 $0 0 $0 1,542 $91,175 26 $2,608 66 $6,323 0 $0 0 $0 985 $40,766 28 $10,717 0 $0 0 $0 0 $0 0 $0 0 $0 19 $1,813 $153,402
West Virginia 0 $0 0 $0 31 $5,703 815 $195,225 0 $0 10 $4,273 0 $0 0 $0 572 $41,765 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $246,966
Wisconsin 0 $0 0 $0 0 $0 0 $0 0 $0 91 $52,519 221 $71,052 0 $0 410 $34,999 237 $53,737 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $212,307
Wyoming 140 $1,777 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $1,777
Total 51,351 $11,040,838 18 $607,747 10,083 $4,433,756 19,842 $3,249,527 14,875 $1,128,935 2,924 $2,235,330 1,631 $413,464 536 $301,346 25,629 $3,429,219 4,941 $2,212,794 6,283 $1,292,086 18,005 $1,852,649 1 $125 60 $36,922 28 $106,026 9,733 $923,914 $33,264,678

Table 7

State / Territory Quality Management Program Administration Other Total
Alabama $280,745 $1,311,435 $0 $1,592,180
Alaska $13,226 $51,682 $16,218 $81,126
American Samoa -- -- -- --
Arizona $27,327 $1,641,401 $8,889 $1,677,617
Arkansas $0 $325,843 $1,144 $326,987
California $43,361 $147,975 $0 $191,336
Colorado $202,876 $362,425 $650,728 $1,216,029
Connecticut -- -- -- --
Delaware $82,822 $384,553 $0 $467,375
District of Columbia $385,793 $1,369,960 $0 $1,755,753
Federated States of Micronesia -- -- -- --
Florida $267,524 $1,986,007 $0 $2,253,531
Georgia $374,471 $5,176,029 $1,400,000 $6,950,500
Guam -- -- -- --
Hawaii $32,625 $231,284 $0 $263,909
Idaho $63,180 $136,344 $0 $199,524
Illinois $241,460 $58,871 $0 $300,331
Indiana $264,233 $1,092,163 $0 $1,356,396
Iowa $74,955 $1,262,020 $0 $1,336,975
Kansas $0 $0 $0 $0
Kentucky -- -- -- --
Louisiana $0 $877,734 $0 $877,734
Maine $27,089 $162,714 $0 $189,803
Marshall Islands -- -- -- --
Maryland $494,500 $1,378,958 $0 $1,873,458
Massachusetts $643,952 $348,545 $0 $992,497
Michigan $130,180 $576,104 $0 $706,284
Minnesota $156,134 $439,300 $0 $595,434
Mississippi $87,628 $2,587,139 $0 $2,674,767
Missouri $0 $0 $0 $0
Montana $21,833 $110,594 $0 $132,427
Nebraska $10,000 $237,698 $0 $247,698
Nevada $189,200 $352,737 $0 $541,937
New Hampshire $67,894 $98,468 $110,785 $277,147
New Jersey $290,751 $3,050,929 $0 $3,341,680
New Mexico $192,204 $50,000 $142,240 $384,444
New York $0 $0 $0 $0
North Carolina $72,848 $2,391,664 $0 $2,464,512
North Dakota $11,165 $95,679 $0 $106,844
Northern Mariana Islands -- -- -- --
Ohio $0 $0 $0 $0
Oklahoma $0 $0 $0 $0
Oregon $97,183 $3,072,676 $0 $3,169,859
Pennsylvania $169,861 $771,853 $0 $941,714
Puerto Rico $282,406 $1,901,407 $0 $2,183,813
Republic of Palau -- -- -- --
Rhode Island -- -- -- --
South Carolina $220,564 $353,577 $0 $574,141
South Dakota $0 $0 $0 $0
Tennessee $0 $0 $0 $0
Texas -- -- -- --
Utah -- -- -- --
Vermont -- -- -- --
Virgin Islands (U.S.) $43,361 $147,975 $0 $191,336
Virginia $372,911 $18,336,942 $0 $18,709,853
Washington $405,585 $698,150 $0 $1,103,735
West Virginia $12,000 $136,518 $0 $148,518
Wisconsin $158,687 $676,003 $0 $834,690
Wyoming $27,596 $61,887 $0 $89,483
Total $6,540,130 $54,453,243 $2,330,004 $63,323,377

Table 8

State / Territory FY2015 ADAP Expenditures
  Prescription Drugs Prescription Dispensing Costs Insurance Premiums Insurance Co-payments and Deductibles Client Outreach Adherence and Monitoring2 Quality Management Program Administration Other3 Total Expenditures
Alabama $7,748,029 $250,000 $120,000 $309,041 $154,760 $792,564 $174,193 $772,350 $0 $10,320,937
Alaska $1,003,273 $81,313 $477,813 $0 $0 $0 $0 $0 $0 $1,562,399
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona $780,074 $238,242 $953,982 $3,407,927 $0 $243,184 $47,050 $1,768,438 $0 $7,438,897
Arkansas $4,827,467 $5,333 $0 $451,957 $0 $0 $0 $0 $0 $5,284,757
California $253,235,906 $1,150,380 $0 $37,154,601 $0 $0 $0 $3,023,128 $4,629,164 $299,193,179
Colorado $3,005,619 $505,409 $2,916,060 $5,148,238 $0 $0 $0 $2,221,137 $3,908,599 $17,705,062
Connecticut -- -- -- -- -- -- -- -- -- --
Delaware $801,690 $24,595 $133,996 $0 $0 $0 $131,095 $343,098 $0 $1,434,474
District of Columbia $10,975,004 $1,308,751 $1,159,813 $541,013 $180,461 $401,701 $19,545 $695,729 $0 $15,282,017
Federated States of Micronesia -- -- -- -- -- -- -- -- -- --
Florida $104,583,337 $8,130,092 $8,072,649 $0 $0 $0 $0 $1,525,918 $0 $122,311,996
Georgia $45,443,332 $1,558,567 $2,381,765 $23,500 $0 $0 $0 $966,955 $0 $50,374,119
Guam -- -- -- -- -- -- -- -- -- --
Hawaii $1,306,766 $25,665 $230,464 $525,984 $0 $0 $0 $135,336 $0 $2,224,215
Idaho $3,802,696 $0 $0 $0 $0 $0 $0 $356,540 $0 $4,159,236
Illinois $26,490,210 $944,071 $7,311,758 $4,975,994 $0 $178,555 $0 $1,156,861 $0 $41,057,449
Indiana $10,762,478 $262,182 $10,066,785 $7,940,582 $0 $0 $0 $0 $0 $29,032,027
Iowa $1,117,841 $30,000 $751,610 $530,830 $0 $0 $63,834 $784,778 $0 $3,278,893
Kansas $7,928,358 $33,348 $1,447,975 $4,820,756 $0 $0 $0 $0 $0 $14,230,437
Kentucky -- -- -- -- -- -- -- -- -- --
Louisiana $0 $0 $4,561,096 $141,474 $0 $0 $0 $0 $0 $4,702,570
Maine $1,021,358 $2,730 $435,212 $612,631 $0 $0 $37,170 $221,554 $0 $2,330,655
Marshall Islands -- -- -- -- -- -- -- -- -- --
Maryland $24,567,232 $224,978 $7,978,684 $10,230,181 $0 $1,258,268 $1,357,264 $1,778,192 $0 $47,394,799
Massachusetts $377,100 $2,215 $5,463,760 $2,194,348 $0 $670,147 $0 $596,555 $0 $9,304,125
Michigan $9,125,528 $80,755 $1,741,354 $8,729,930 $0 $1,318 $31,439 $923,318 $0 $20,633,642
Minnesota $3,762,624 $22,685 $1,302,292 $0 $0 $0 $0 $0 $0 $5,087,601
Mississippi $12,827,693 $0 $0 $0 $0 $0 $87,628 $0 $0 $12,915,321
Missouri $29,296,777 $1,870,007 $8,132,934 $825,386 $0 $0 $0 $0 $0 $40,125,104
Montana $148,258 $7,000 $0 $168,124 $0 $0 $0 $0 $0 $323,382
Nebraska $1,701,960 $6,672 $0 $0 $0 $0 $0 $333,101 $0 $2,041,733
Nevada $5,180,899 $71,317 $644,287 $277,932 $0 $889,380 $33,767 $86,640 $0 $7,184,222
New Hampshire $1,311,737 $4,478 $378,767 $596,015 $0 $0 $0 $0 $0 $2,290,997
New Jersey $69,747,385 $353,750 $5,569,455 $0 $0 $0 $0 $703,695 $0 $76,374,285
New Mexico $298,894 $11,886 $2,101,423 $99,350 $0 $0 $56,431 $481,490 $0 $3,049,474
New York $313,682,123 $2,289,066 $30,622,323 $0 $520,000 $1,888,852 $680,000 $2,800,000 $0 $352,482,364
North Carolina $42,961,662 $2,338,211 $0 $3,831,284 $0 $0 $0 $313,703 $0 $49,444,860
North Dakota $830,079 $7,299 $46,720 $161,078 $0 $0 $0 $0 $0 $1,045,176
Northern Mariana Islands -- -- -- -- -- -- -- -- -- --
Ohio $5,207,610 $174,215 $1,668,879 $4,253,434 $0 $0 $0 $811,428 $0 $12,115,566
Oklahoma $1,376,461 $222,962 $5,860,435 $1,689,993 $0 $141,351 $0 $0 $462,212 $9,753,414
Oregon $1,490,001 $1,719,078 $2,716,000 $13,293,000 $297,779 $0 $48,592 $2,434,075 $214,885 $22,213,410
Pennsylvania $84,026,992 $1,010,648 $299,282 $6,687,201 $0 $428,130 $0 $1,606,121 $0 $94,058,374
Puerto Rico $60,946,948 $35,896 $0 $1,155,283 $0 $308,727 $39,676 $1,901,407 $0 $64,387,937
Republic of Palau -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- --
South Carolina $16,211,998 $685,736 $3,939,936 $6,229,840 $0 $0 $0 $365,256 $0 $27,432,766
South Dakota $2,516,763 $0 $0 $0 $0 $0 $0 $0 $0 $2,516,763
Tennessee $11,151,906 $306,759 $9,171,297 $7,973,883 $0 $0 $0 $0 $0 $28,603,845
Texas $106,015,750 $550,815 $0 $9,077,685 $0 $0 $0 $6,761,911 $0 $122,406,161
Utah -- -- -- -- -- -- -- -- -- --
Vermont $0 $0 $33,692 $0 $0 $0 $0 $0 $0 $33,692
Virgin Islands (U.S.) $1,405,902 $37,508 $0 $156,972 $0 $0 $10,935 $25,000 $0 $1,636,317
Virginia $4,167,534 $318,504 $5,855,770 $12,830,356 $0 $0 $43,343 $1,308,073 $0 $24,523,580
Washington $7,920,822 $222,982 $7,888,824 $4,799,471 $0 $0 $348,828 $586,494 $0 $21,767,421
West Virginia $2,988,862 $28,799 $138,592 $510,155 $0 $0 $6,000 $14,790 $0 $3,687,198
Wisconsin $8,347,497 $65,634 $2,336,898 $2,693,769 $0 $0 $84,053 $155,144 $0 $13,682,995
Wyoming $83,867 $0 $0 $110,849 $0 $0 $0 $0 $0 $194,716
Total $1,314,512,302 $27,220,533 $144,912,582 $165,160,047 $1,153,000 $7,202,177 $3,300,843 $37,958,215 $9,214,860 $1,710,634,559

Table 9

State / Territory Private Insurance Medicaid Other Total
Alabama $0 $120,000 $0 $120,000
Alaska $2,433,794 $0 $0 $2,433,794
American Samoa -- -- -- --
Arizona $0 $7,660 $3,543 $11,203
Arkansas $0 $0 $0 $0
California $766,103 $1,806,830 $0 $2,572,933
Colorado $0 $0 $0 $0
Connecticut -- -- -- --
Delaware $0 $0 $0 $0
District of Columbia $0 $0 $0 $0
Federated States of Micronesia -- -- -- --
Florida $0 $0 $0 $0
Georgia $0 $0 $0 $0
Guam -- -- -- --
Hawaii $0 $0 $0 $0
Idaho $0 $0 $0 $0
Illinois $0 $12,385 $0 $12,385
Indiana $0 $0 $0 $0
Iowa $30,715 $19,705 $0 $50,420
Kansas $0 $0 $0 $0
Kentucky -- -- -- --
Louisiana $0 $0 $0 $0
Maine $0 $0 $0 $0
Marshall Islands -- -- -- --
Maryland $41,096 $0 $0 $41,096
Massachusetts $0 $0 $0 $0
Michigan $20,306 $579,182 $0 $599,488
Minnesota $0 $0 $0 $0
Mississippi $0 $0 $0 $0
Missouri $0 $0 $0 $0
Montana $0 $0 $0 $0
Nebraska $111,272 $32,714 $0 $143,986
Nevada $0 $0 $0 $0
New Hampshire $0 $0 $0 $0
New Jersey $0 $0 $0 $0
New Mexico $0 $0 $25,922 $25,922
New York $14,500,000 $1,500,000 $0 $16,000,000
North Carolina $0 $0 $0 $0
North Dakota $0 $0 $0 $0
Northern Mariana Islands -- -- -- --
Ohio $0 $0 $0 $0
Oklahoma $20,000 $9,000 $0 $29,000
Oregon $31,866,000 $0 $0 $31,866,000
Pennsylvania $16,000,000 $0 $0 $16,000,000
Puerto Rico $36,000,000 $39,178,884 $0 $75,178,884
Republic of Palau -- -- -- --
Rhode Island -- -- -- --
South Carolina $17,386,883 $0 $1,141,408 $18,528,291
South Dakota $0 $0 $0 $0
Tennessee $0 $0 $0 $0
Texas $0 $0 $0 $0
Utah $0 $0 $0 $0
Vermont $0 $0 $0 $0
Virgin Islands (U.S.) $0 $0 $0 $0
Virginia $107,909 $214,274 $0 $322,183
Washington $117,571 $50,852 $35,792 $204,215
West Virginia $0 $20,000 $0 $20,000
Wisconsin $56,995 $1,500,000 $0 $1,556,995
Wyoming $0 $0 $0 $0
Totals $119,458,644 $45,051,486 $1,206,665 $165,716,795
Total # of ADAPs 13 14 4 19

Section Three

Comprehensive Care for People Living with HIV

The Evolution of Insurance Purchasing

As clarification from HRSA became available, ADAPs began purchasing insurance for clients in 2002. In FY2009, 43 ADAPs reported using funds for insurance purchasing/continuation, representing $161.8 million in estimated expenditures (10% of the ADAP budget at that time) for 30,621 ADAP clients, with an average cost per client of $5,284. In March 2010, President Obama signed into law the Patient Protection and Affordable Care Act (Affordable Care Act, ACA). The progression of health reform has enhanced health coverage to many uninsured persons living with HIV. In CY2015, 47 ADAPs reported using funds for insurance purchasing, representing $337.6 million in actual expenditures (17% of the ADAP budget) for 124,099 ADAP clients (55%), with an average cost per client of $2,720.

The ACA revolutionized how ADAPs and Part B programs could engage in insurance purchase and maintenance for clients. Because of this increased engagement, and, generally, access to more options for coverage for clients, the cost of purchasing insurance for clients was reduced; ADAPs no longer had to rely on high-risk insurance pools or other high-cost plans for their clients. As a result, national ADAP enrollment has shifted dramatically and continues to trend toward greater numbers of insured clients in the program. This shift in coverage is discussed in greater detail in Section Four.

The Implementation of Health Reform and Cost-Sharing

Health Reform

Chart 12

ADAP Clients Served, by Program Type, Calendar Year 2015

ADAP Clients Served, by Program Type, Calendar Year 2015

Chart 13

ADAP Clients Served, by State Medicaid Expansion, Calendar Year 2015

ADAP Clients Served, by State Medicaid Expansion, Calendar Year 2015

Chart 15

ADAP Clients Served, by ACA Marketplace Type

ADAP Clients Served, by ACA Marketplace Type

Health reform throughout the U.S. has been implemented unequally across states, creating new disparities and illuminating further stressors on the public health system. Medicaid expansion under the ACA allows states to extend eligibility to individuals with income up to 138% FPL regardless of traditional Medicaid categories of eligibility, such as disability and pregnancy7. Marketplaces, created under the ACA, utilize outreach and enrollment staff and streamlined application processes that screen for Medicaid eligibility and eligibility for premium tax credits and cost-sharing reductions for Qualified Health Plans (QHPs). ADAPs have assisted tens of thousands of individuals with the premiums and other cost sharing associated with QHP coverage. Disparities continue to exist among states that have and have not expanded Medicaid. As of February 2017, 31 states and the District of Columbia had expanded Medicaid; almost half of all ADAP clients reside in the 19 states that have not expanded Medicaid. Those states are primarily in the southern region, further illuminating inequities in access to care and treatment via public payers. The majority (58%) of clients served by ADAP in June 2015 had incomes below 138% of the Federal Poverty Level (FPL).

As our nation’s health care system and public health programs continue to grow and change, ADAPs themselves have undergone and continue to experience significant transformations in their structure and service provision to ensure access to care and treatment for PLWH. This includes assisting clients in accessing new forms of medications and medical coverage as well as maintaining vital services that strengthen those available through the Ryan White Program. ADAPs’ nimble and progressive approach has positioned the program as a sustainable model for optimizing health outcomes for the clients ADAPs serve and as a critical component of the broader health system.

Cost-Sharing

ADAP remains the primary payer for those individuals whose insurance cost-sharing responsibilities (e.g., premium, deductible, and co-payment/co-insurance) are a barrier to purchasing and maintaining insurance. While the ACA includes an unprecedented expansion in access to both private and public health insurance, the cost of insurance often remains too high for many individuals, even with the availability of federal subsidies. The Ryan White Program allows states to use ADAP funds to purchase health insurance and pay insurance premiums, co-payments and/or deductibles for individuals eligible for ADAP, provided the insurance has comparable formulary benefits to that of the ADAP and is cost-effective to the ADAP. By purchasing and continuing insurance on behalf of clients, ADAPs have ensured access to treatment and care services beyond the scope of the traditional Ryan White Program. Today, the majority of ADAPs pay premiums (84%), deductibles (84%) and prescription co-payments/co-insurance (94%) on behalf of eligible clients. Half of ADAPs also pay medical co-payments/co-insurance8 on behalf of clients. With a significantly lower average cost per client ($2,720) relative to full-pay prescriptions ($8,663), insurance continuation continues to be cost-effective for ADAPs.

Forty-seven ADAPs reported using funds for insurance purchasing/continuation in 2015 representing $338 million in expenditures in CY2015. In CY2015, 124,099 ADAP clients were covered by ADAP insurance coordination.

Some private insurance plans (Qualified Health Plans, employer-sponsored plans, and other individual health plans) place HIV ARVs on a higher tier than other medications, resulting in high cost-sharing for clients. In many cases, when medications are placed on high or specialty tiers, instead of charging a co-payment with a fixed dollar amount, plans will charge a co-insurance, or a percentage of the cost of the drug. This results in much higher cost-sharing responsibilities for clients. To ensure continuous access to treatment, ADAPs purchase or continue insurance by paying for prescription co-payments or co-insurance on behalf of clients, closely interacting with other existing payer sources with ADAP serving as the payor of last resort.

7 In 2014, the ACA expanded Medicaid eligibility to most people with income up to 133% of the federal poverty level (FPL). However, in addition to new income accounting rules for most Medicaid populations (called “Modified Adjusted Gross Income”), there is an additional 5% disregard of income in calculating eligibility, effectively bumping the Medicaid income eligibility threshold to 138% FPL.

8 Federal ADAP funds cannot be used to pay for medical co-payments/co-insurance. Part B or state funding are used for these purposes.

  View Larger

Chart 14

ADAP Clients Served and Estimated Expenditures in Insurance Purchasing and Continuation, 20161

ADAP Clients Served and Estimated Expenditures in Insurance Purchasing and Continuation, 2016<sup>1</sup>

Table 10

State / Territory Calendar Year 2016 Estimated Expenditures Calendar Year 2015 Expenditures
  Insurance Premiums Insurance Deductibles Insurance Co-payments/Co-insurance Other
Alabama $18,000,000 $8,105,618 $881,709 $79,039 $0
Alaska $239,114 $477,813 $0 $0 $0
American Samoa -- -- -- -- --
Arizona $4,362,137 $953,983 $29,677 $3,378,477 $0
Arkansas $500,000 $0 $225,000 $100,000 $0
California $48,391,540 $12,668,642 $39,063,891 $0 $0
Colorado $15,867,898 $2,916,060 $0 $5,148,238 $0
Connecticut -- -- -- -- --
Delaware $90,000 $133,996 $0 $0 $0
District of Columbia $1,209,507 $618,800 $0 $541,013 $0
Federated States of Micronesia -- -- -- -- --
Florida $21,500,000 $8,144,602 $0 $8,072,649 $0
Georgia $5,261,556 $2,381,765 $0 $23,500 $0
Guam -- -- -- -- --
Hawaii $825,000 $223,072 $0 $486,500 $0
Idaho $0 $0 $0 $0 $0
Illinois $13,000,000 $7,311,758 $4,975,994 $0 $0
Indiana $32,677,157 $10,066,785 $2,352,743 $0 $0
Iowa $1,800,000 $751,610 $3,063 $527,766 $0
Kansas $1,527,000 $1,447,975 $0 $4,820,756 $0
Kentucky -- -- -- -- --
Louisiana $10,735,000 $4,561,096 $0 $141,474 $0
Maine $1,167,529 $435,212 $47,056 $554,436 $11,138
Marshall Islands -- -- -- -- --
Maryland $18,413,181 $7,978,684 $1,029,157 $9,201,024 $0
Massachusetts $8,000,000 $5,463,760 $0 $2,191,502 $0
Michigan $1,200,000 $810,951 $14,231,431 $1,165,726 $0
Minnesota $1,500,000 $1,302,292 $980,000 $230,000 $0
Mississippi $0 $0 $0 $0 $0
Missouri $11,000,000 $8,132,934 $0 $825,387 $0
Montana $310,302 $0 $276,920 $114,582 $0
Nebraska $1,300,033 $1,800,000 $0 $1,242,280 $0
Nevada $12,793,974 $406,210 $0 $1,141,306 $0
New Hampshire $1,100,000 $387,767 $0 $596,015 $0
New Jersey $6,400,000 $8,143,248 $0 $0 $0
New Mexico $1,831,222 $1,472,302 $0 $99,350 $0
New York $30,622,323 $30,622,323 $0 $0 $0
North Carolina -- $0 $0 $3,831,284 $0
North Dakota $150,000 $46,720 $0 $161,078 $0
Northern Mariana Islands -- -- -- -- --
Ohio $6,400,000 $1,668,879 $254,100 $3,999,334 $0
Oklahoma $9,000,000 $5,860,435 $0 $1,689,993 $0
Oregon $15,000,000 $2,716,000 $13,293,000 $0 $0
Pennsylvania $7,000,000 $297,689 $0 $6,687,201 $0
Puerto Rico $1,227,012 $0 $0 $1,155,283 $0
Republic of Palau -- -- -- -- --
Rhode Island -- -- -- -- --
South Carolina $15,664,160 $3,950,423 $2,785,687 $3,450,606 $0
South Dakota $0 $0 $0 $0 $0
Tennessee $10,000,000 $9,171,270 $4,808,477 $3,165,407 $0
Texas $9,000,000 $699,371 $0 $8,935,161 $0
Utah -- $670,289 $0 $943,228 $0
Vermont -- $33,692 $0 $0 $0
Virgin Islands (U.S.) $150,000 $0 $156,972 $0 $0
Virginia $35,708,867 $5,749,286 $0 $4,393,248 $0
Washington $8,500,000 $7,888,824 $10,362 $17,987 $0
West Virginia $724,000 $138,592 $28,139 $482,017 $0
Wisconsin $5,302,200 $2,336,898 $2,693,769 $0 $0
Wyoming $894,901 $0 $288,280 $606,641 $0
Total $396,345,613 $168,947,626 $88,415,427 $80,199,488 $11,138

Table 11

State / Territory Ryan White Part B, Including ADAP ADAP Only
  Calendar Year 2015 Clients Enrolled Calendar Year 2015 Clients Served Calendar Year 2015 Clients Enrolled Calendar Year 2015 New Clients Enrolled Calendar Year 2015 Clients Enrolled and Recertified Twice in 12-Month Period Calendar Year 2015 Clients Served1
  Clients Enrolled Recertified Twice in 12-Month Period Full-Pay Medications Only ADAP-Funded Insurance Only2 Full-Pay Medications and ADAP-Funded Insurance3 Total Clients Served
Alabama -- -- -- 2,697 502 2,109 1,638 890 169 2,697
Alaska 329 326 266 144 25 137 40 62 35 137
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona 2,876 1,243 2,757 2,591 495 1,731 668 1,261 187 2,116
Arkansas 1,767 1,515 1,515 701 325 495 495 148 0 643
California -- -- -- 34,933 3,230 26,276 13,440 16,392 0 29,832
Colorado 2,216 1,924 2,196 4,532 772 4,197 338 3,687 483 4,508
Connecticut -- -- -- -- -- -- -- -- -- --
Delaware 1,830 1,138 1,284 1,830 173 1,138 0 0 1,284 1,284
District of Columbia 2,475 1,501 2,393 1,426 238 1,188 637 282 221 1,140
Federated States of Micronesia -- -- -- -- -- -- -- -- -- --
Florida 22,223 20,690 20,943 22,223 3,447 20,690 15,395 2,557 2,951 20,903
Georgia 15,549 9,505 10,114 10,783 2,675 8,260 8,951 544 0 9,495
Guam -- -- -- -- -- -- -- -- -- --
Hawaii 904 -- 898 408 65 226 90 249 32 371
Idaho 253 132 253 233 48 106 233 0 0 233
Illinois 4,907 3,166 4,907 10,522 1,604 7,634 3,996 2,235 1,476 7,707
Indiana 3,235 1,707 2,857 2,857 547 1,707 314 1,542 1,001 2,857
Iowa 1,218 1,218 1,218 489 107 313 89 280 90 459
Kansas 1,140 633 1,128 1,620 325 1,178 183 1,007 182 1,372
Kentucky -- -- -- -- -- -- -- -- -- --
Louisiana 8,852 5,465 7,985 7,814 1,682 4,468 1,902 3,711 1,330 6,943
Maine 995 819 629 995 95 819 38 594 72 704
Marshall Islands -- -- -- -- -- -- -- -- -- --
Maryland -- -- 1,606 7,291 413 3,401 924 260 4,470 5,654
Massachusetts 5,324 -- 5,324 7,962 605 3,229 224 5,717 4 5,945
Michigan 2,838 -- 2,583 3,505 450 2,740 14 926 2,340 3,280
Minnesota 2,647 2,647 2,100 1,634 311 78 316 126 878 1,320
Mississippi 2,277 1,466 2,277 2,277 514 989 2,277 0 0 2,277
Missouri 7,183 5,183 7,122 5,042 1,211 3,465 947 1,947 819 3,713
Montana 1 304 289 304 304 71 288 37 119 148 304
Nebraska 869 821 821 803 148 0 233 368 127 728
Nevada 2,142 1,009 2,142 1,264 319 787 485 639 140 1,264
New Hampshire 624 524 479 624 27 524 104 129 246 479
New Jersey 6,294 5,847 5,718 6,294 851 5,847 3,353 778 1,587 5,718
New Mexico 1,538 674 1,538 505 60 322 27 424 23 474
New York 22,916 22,916 22,916 25,566 2,232 25,566 0 0 22,916 22,916
North Carolina 9,886 9,886 9,886 9,321 1,325 7,122 6,600 1,363 325 8,288
North Dakota 229 145 229 229 64 145 44 54 80 178
Northern Mariana Islands -- -- -- -- -- -- -- -- -- --
Ohio 6,844 3,637 4,795 6,226 750 3,522 883 2,331 809 4,023
Oklahoma -- -- -- 1,874 310 1,555 214 1,315 326 1,855
Oregon 1,141 895 1,141 3,632 353 3,533 5 3,446 181 3,632
Pennsylvania 18,787 13,684 14,559 8,460 2,444 -- 3,955 1,485 2,216 7,656
Puerto Rico 9,759 2,343 7,988 8,484 669 7,134 7,571 368 49 7,988
Republic of Palau -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- --
South Carolina 8,816 8,127 8,816 6,006 809 4,073 2,407 1,924 1,249 5,580
South Dakota 310 156 302 310 19 156 272 0 0 272
Tennessee 7,421 -- 6,128 5,873 780 -- 1,419 4,116 0 5,535
Texas -- -- -- 22,522 2,847 0 16,853 2,310 251 19,414
Utah -- -- -- 855 149 -- 294 334 129 757
Vermont 570 570 570 337 32 329 2 327 0 329
Virgin Islands (U.S.) 218 207 218 179 4 179 119 36 0 155
Virginia 5,738 -- 5,041 6,836 903 2,202 1,975 3,078 1,282 6,335
Washington 6,978 6,458 6,978 3,982 392 3,358 628 625 2,533 3,786
West Virginia 1,139 1,122 1,108 607 72 562 108 333 166 607
Wisconsin 4,440 4,440 4,440 1,654 220 954 653 200 661 1,514
Wyoming 140 128 140 140 15 128 28 112 0 140
Total 208,141 144,156 188,612 257,396 35,724 164,860 101,418 70,631 53,468 225,517

Table 12

State / Territory Medicaid Medicaid and Medicare Medicare Part D Full Subsidy1 Medicare Part D Partial Subsidy Medicare Part D Standard Benefit Private Insurance Coverage No Form of Insurance Unknown
  Enrolled in QHP on the ACA Marketplace Enrolled in QHP off the ACA Marketplace Enrolled in Other Private Insurance Unknown Total Private Insurance
Alabama 0 0 0 0 78 0% 100% 0% 0% 981 1,638 0
Alaska 0 0 7 2 6 56% 0% 44% 0% 82 40 0
American Samoa -- -- -- -- -- -- -- -- -- -- -- --
Arizona 109 6 168 73 396 58% 0% 42% 0% 764 600 0
Arkansas 0 0 0 148 0 0% 0% 0% 0% 0 495 0
California 196 5,265 452 136 2,874 21% 0% 0% 79% 7,467 13,440 2
Colorado 1,252 508 412 75 331 32% 5% 62% 0% 1,528 338 64
Connecticut -- -- -- -- -- -- -- -- -- -- -- --
Delaware 632 0 100 13 97 27% 0% 73% 0% 351 76 15
District of Columbia 86 129 98 0 0 0% 0% 0% 100% 430 250 147
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- --
Florida 0 0 222 195 1,174 74% 0% 33% 0% 3,684 15,628 0
Georgia 62 0 601 462 25 22% 0% 78% 0% 792 7,511 42
Guam -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 2 0 29 6 83 19% 5% 75% 0% 159 90 0
Idaho 0 0 0 0 0 0% 0% 0% 0% 0 233 0
Illinois 1,552 140 162 109 575 57% 0% 43% 0% 2,855 2,314 0
Indiana 55 0 0 0 0 16% 60% 0% 24% 2,320 356 504
Iowa 1 3 17 7 62 17% 41% 42% 0% 280 89 0
Kansas 151 126 58 18 88 61% 7% 32% 0% 771 128 32
Kentucky -- -- -- -- -- -- -- -- -- -- -- --
Louisiana 0 0 846 118 336 81% 8% 11% 0% 3,741 1,902 0
Maine 368 131 0 0 26 47% 1% 52% 0% 141 38 0
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- --
Maryland 0 1 66 31 1,366 32% 11% 57% 0% 3,266 924 0
Massachusetts 2,681 1,195 0 0 294 0% 0% 0% 100% 1,551 224 0
Michigan 0 0 300 101 410 12% 0% 88% 0% 1,653 14 802
Minnesota 118 37 5 3 57 22% 27% 51% 0% 988 112 0
Mississippi 0 0 0 0 0 0% 0% 0% 0% 0 2,277 0
Missouri 269 69 55 15 120 71% 4% 25% 0% 2,238 947 0
Montana 3 0 46 33 33 60% 10% 20% 10% 81 35 73
Nebraska 8 0 34 12 33 31% 24% 45% 0% 408 233 0
Nevada 84 45 105 45 143 0% 0% 0% 100% 370 296 176
New Hampshire 6 95 29 24 43 20% 0% 80% 0% 282 0 0
New Jersey 0 0 77 17 283 2% 14% 0% 84% 1,988 3,353 0
New Mexico 0 0 13 7 11 31% 48% 21% 0% 416 27 0
New York 165 522 2,062 458 2,750 0% 0% 0% 100% 7,563 8,840 556
North Carolina 0 0 1,131 269 158 100% 0% 0% 0% 158 6,572 0
North Dakota 23 10 4 0 7 21% 3% 76% 0% 97 37 0
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- --
Ohio 546 36 718 135 441 39% 0% 61% 0% 1,349 798 0
Oklahoma 0 72 130 37 154 81% 0% 19% 0% 1,251 211 0
Oregon 1,117 654 0 102 460 20% 31% 49% 0% 1,294 5 0
Pennsylvania 1,826 333 381 67 1,097 0% 0% 0% 100% 2,281 1,671 0
Puerto Rico 7,530 0 26 0 0 0% 0% 100% 0% 342 90 0
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- --
South Carolina 0 0 48 50 239 48% 7% 23% 22% 2,851 2,392 0
South Dakota 29 11 26 3 8 83% 11% 7% 0% 178 17 0
Tennessee 0 0 0 0 0 67% 32% 0% 2% 4,116 1,419 0
Texas 865 0 0 372 1,859 0% 0% 100% 0% 445 15,873 0
Utah 0 0 5 4 16 37% 30% 33% 0% 438 294 0
Vermont 106 62 52 10 35 54% 0% 40% 0% 65 2 0
Virgin Islands (U.S.) 0 0 0 0 0 0% 0% 100% 0% 36 119 0
Virginia 0 0 0 218 287 89% 0% 11% 0% 3,904 1,926 0
Washington 73 324 585 86 331 48% 25% 27% 0% 1,684 703 0
West Virginia 13 46 71 29 25 18% 1% 79% 2% 315 108 0
Wisconsin 33 93 12 192 75 64% 0% 36% 0% 456 653 0
Wyoming 13 13 19 1 9 78% 5% 16% 0% 55 28 2
Total 19,974 9,926 9,172 3,683 16,895 38% 10% 22% 31% 68,465 95,366 2,415

Table 13

State / Territory Calendar Year 2015 Clients Served ADAP-Funded Insurance Premium Only1 Deductible / Co-pay / Co-insurance Only Premium and Deductible / Co-pay / Co-insurance
Alabama 1,059 0 0 1,059
Alaska 97 0 0 97
American Samoa -- -- -- --
Arizona 1,448 110 860 478
Arkansas 148 0 148 0
California 16,392 274 13,019 3,099
Colorado 4,170 54 865 3,251
Connecticut -- -- -- --
Delaware 1,284 95 0 1,189
District of Columbia 503 125 378 0
Federated States of Micronesia -- -- -- --
Florida 5,508 2,557 0 2,951
Georgia 544 532 0 12
Guam -- -- -- --
Hawaii 281 40 188 53
Idaho 0 0 0 0
Illinois 3,711 728 1,306 1,677
Indiana 2,543 0 559 2,320
Iowa 370 25 200 145
Kansas 1,189 34 800 355
Kentucky -- -- -- --
Louisiana 5,041 2,125 1,246 1,670
Maine 666 36 458 172
Marshall Islands -- -- -- --
Maryland 4,730 388 2,479 1,863
Massachusetts 5,721 233 4,191 1,297
Michigan 3,266 235 1,116 1,915
Minnesota 1,004 0 126 878
Mississippi 0 0 0 0
Missouri 2,766 384 734 1,648
Montana 267 0 119 148
Nebraska 495 1 268 226
Nevada 779 116 385 278
New Hampshire 375 6 160 209
New Jersey 2,365 0 778 1,587
New Mexico 447 270 72 106
New York 22,916 6,368 0 16,548
North Carolina 1,688 0 1,688 0
North Dakota 134 10 100 24
Northern Mariana Islands -- -- -- --
Ohio 3,140 0 1,501 1,639
Oklahoma 1,641 156 486 999
Oregon 3,627 61 1,232 2,334
Pennsylvania 3,701 52 2,661 988
Puerto Rico 417 0 417 0
Republic of Palau -- -- -- --
Rhode Island -- -- -- --
South Carolina 3,173 68 1,793 1,312
South Dakota 0 0 0 0
Tennessee 4,116 452 288 3,376
Texas 2,561 47 2,420 94
Utah 463 20 130 313
Vermont 327 0 0 327
Virgin Islands (U.S.) 36 0 36 0
Virginia 4,360 463 592 3,305
Washington 3,158 1,644 303 1,211
West Virginia 499 0 445 54
Wisconsin 861 200 0 661
Wyoming 112 0 56 56
Total 124,099 17,909 44,603 61,924

Table 14

State / Territory ADAP Pays Deductibles ADAP Pays Co-payments / Co-insurance (prescription only) ADAP Pays Co-payments / Co-insurance (medical only 1) ADAP Requires Advance Tax Credit 2 ADAP Requires Tax Return Submission
  Below 100% FPL 100-138% FPL 138-250% FPL 250-400% FPL 400% FPL and higher Below 100% FPL 100-138% FPL 138-250% FPL 250-400% FPL 400% FPL and higher Below 100% FPL 100-138% FPL 138-250% FPL 250-400% FPL 400% FPL and higher 100-138% FPL 138-250% FPL 100-138% FPL 138-250% FPL
Alabama Yes Yes Yes No No Yes Yes Yes No No Yes Yes Yes No No No No N/A N/A
Alaska Yes Yes Yes Yes No Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes
Arkansas Yes Yes No No No Yes Yes No No No No No No No No N/A N/A N/A N/A
California Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes N/A Yes
Colorado Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes
Connecticut -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Delaware No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
District of Columbia No No No No Yes No No No No Yes No No No No Yes N/A N/A N/A N/A
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -
Florida No Yes Yes No No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes
Georgia No No No No No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No Yes N/A Yes
Idaho No No No No No No No No No No No No No No No N/A N/A N/A N/A
Illinois Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes
Indiana Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No N/A N/A
Iowa No No Yes Yes No No No Yes Yes No No No Yes Yes No No No N/A N/A
Kansas Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes
Kentucky -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Louisiana Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No N/A N/A
Maine Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes N/A Yes
Massachusetts No No No No No Yes Yes Yes Yes Yes No No No No No No Yes N/A Yes
Michigan No No Yes Yes Yes No No Yes Yes Yes No No No No No No Yes N/A Yes
Minnesota No No Yes Yes No No No Yes Yes No No No No No No No Yes No Yes
Mississippi No No No No No No No No No No No No No No No N/A N/A N/A N/A
Missouri Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes
Montana Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No N/A N/A
Nebraska Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes
Nevada Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes No No
New Hampshire Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes
New Jersey No No Yes Yes Yes No No Yes Yes Yes No No No No No No Yes N/A Yes
New Mexico No No No No No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes
New York Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No
North Carolina Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No N/A N/A N/A N/A
North Dakota Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes No No
Oklahoma Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes
Oregon Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes N/A Yes
Pennsylvania Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No N/A N/A N/A N/A
Puerto Rico Yes Yes Yes No No Yes Yes Yes No No No No No No No N/A N/A N/A N/A
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
South Carolina Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes No No
South Dakota No No No No No No No No No No No No No No No N/A N/A N/A N/A
Tennessee Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes
Texas No No No No No Yes Yes Yes No No No No No No No No No N/A N/A
Utah -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Vermont Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Virgin Islands (U.S.) No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes N/A N/A N/A N/A
Virginia Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes
Washington Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes No No
West Virginia Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes
Wisconsin Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes
Wyoming Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Total 34 36 39 36 17 40 41 44 41 20 21 22 23 22 8 26 34 20 29

Table 15

State / Territory ADAP Pays Premiums ADAP Pays Deductibles ADAP Pays Co-payments Eligible for ADAP Provide Medications During the Donut Hole
  Partial Subsidy Clients Standard Clients Partial Subsidy Clients Standard Clients Dually Eligible Clients Full Subsidy Clients Partial Subsidy Clients Standard Clients Dually Eligible Clients Full Subsidy Clients Partial Subsidy Clients Standard Clients
Alabama N/A N/A N/A N/A N/A N/A N/A N/A No No No No N/A
Alaska No Yes No Yes No Yes Yes Yes No Yes Yes Yes Yes
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Arkansas Yes Yes No No No No Yes No No No Yes No N/A
California Yes Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Colorado Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Connecticut -- -- -- -- -- -- -- -- -- -- -- -- --
Delaware No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes
District of Columbia Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- --
Florida No Yes No Yes No No No Yes No No Yes Yes No
Georgia Yes No Yes No No No Yes Yes No No Yes Yes Yes
Guam -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes
Idaho N/A N/A N/A N/A N/A N/A N/A N/A No No No No N/A
Illinois Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Indiana No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Iowa Yes Yes Yes Yes No No Yes Yes No No Yes Yes Yes
Kansas No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Kentucky -- -- -- -- -- -- -- -- -- -- -- -- --
Louisiana Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Maine No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes
Massachusetts Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes
Michigan Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes
Minnesota No Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes
Mississippi N/A N/A N/A N/A N/A N/A N/A N/A No No No No N/A
Missouri Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes
Montana N/A N/A N/A N/A N/A N/A N/A N/A No No No No N/A
Nebraska No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Nevada Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
New Hampshire Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
New Jersey Yes Yes Yes Yes No Yes Yes Yes No Yes Yes Yes Yes
New Mexico Yes No Yes No No Yes Yes Yes No Yes Yes Yes Yes
New York Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes
North Carolina No Yes No Yes No Yes Yes Yes No Yes Yes Yes Yes
North Dakota Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Oklahoma No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Oregon Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Pennsylvania Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes
Puerto Rico No Yes No Yes No Yes Yes Yes No Yes Yes Yes Yes
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- -- --
South Carolina No Yes No Yes No No Yes Yes No No Yes Yes Yes
South Dakota Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Tennessee No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Texas No No No No No No Yes Yes No No Yes Yes Yes
Utah -- -- -- -- -- -- -- -- -- -- -- -- --
Vermont Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Virgin Islands (U.S.) N/A N/A N/A N/A N/A N/A N/A N/A No No No No N/A
Virginia Yes Yes Yes Yes No No Yes Yes No No Yes Yes Yes
Washington Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
West Virginia No Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Wisconsin Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Wyoming Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Total 28 38 29 37 27 36 43 43 27 36 44 43 42

Section Four

Who Benefits from Services?

ADAP Client Utilization

The Ryan White Program, and ADAPs, provide services for PLWH who are uninsured or under-insured. Individual states set specific eligibility criteria for their programs, depending on state rules, available funding, and client need.

In CY2015, there were 257,396 clients enrolled in ADAPs across the country, a 181% increase in enrollment over the last 10 years. Enrollment varies by state and is concentrated in certain areas—ten states accounted for two-thirds of total enrollment. In general, these states represent those with the highest numbers of PLWH, and the concentration of clients within these states largely reflects the allocation of Ryan White Program funding to states.

Each year, more clients are typically enrolled in ADAPs than seek access to services; in CY2015, 87% of clients enrolled received an ADAP service. This is because clients may seek ADAP services at different times of the year, depending on their clinical needs, length of prescriptions, availability of other resources for obtaining prescription drugs, annual and bi-annual recertification, and other factors. Some individuals cycle on and off ADAP throughout the year, particularly those with Medicaid or Medicare Part D coverage. Medicaid beneficiaries may face limits in their coverage in some states and/or are in the Medicaid spend-down process. Medicare Part D beneficiaries may not use ADAP until they reach the coverage gap (the point in time when Medicare Part D beneficiaries are responsible for all their drug costs), necessitating a return to ADAP.

ADAPs provided medications to 225,517 clients in CY2015, a 235% increase in utilization over the last 10 years. The number of clients served varies considerably by state, ranging from 137 in Alaska to more than 29,000 in California. Similar to the number of clients enrolled, ten states accounted for two-thirds (63%) of all ADAP clients served in CY2015, with four states accounting for almost half (41%) of clients served. In addition to providing medications in CY2015, 124,099 clients benefited from ADAP funds through some form of insurance coverage payment (some of whom may have also received medications).

A Snapshot of ADAP Clients

African Americans and Hispanics represented 61% (38% and 23%, respectively) of clients served in CY2015 (compared to 40% and 21%, respectively, of PLWH in the United States at the end of 20139,10,; white non-Hispanics represented 31% and Asian, Native Hawaiian/Pacific Islanders and American Indians/Alaskan Natives combined represented approximately 3%. Individuals identifying as multi-racial represented approximately 4% of clients served. The race/ethnicity breakdown of ADAP clients varies by state but national ADAP client demographics have remained fairly constant over the course of the National ADAP Monitoring Project, despite changes in demographics of the epidemic within the U.S.

Most ADAP clients are male (78% of those served in CY2015; compared to 76% of PLWH in the United States at the end of 201311; approximately one-fifth (21%) are female (compared to 23% of PLWH in the United States at the end of 201312). One percent of clients served in CY2015 self-identified as transgender. The majority of ADAP clients served are between the ages of 45 and 64 (50%), followed by those between the ages of 25 and 44 years (40%). While the gender breakdown of clients has remained steady over time, increasingly ADAPs are serving an older client population.

More than seven in ten ADAP clients are low-income — 76% served in CY2015 were at or below 200% of the Federal Poverty Level (FPL), including more than half (58%) at or below 138% of FPL (in 2015, the FPL was $11,770 – slightly higher in Alaska and Hawaii – for a household of one). These figures are consistent with data reported in previous periods.

There is no minimum ADAP income eligibility threshold set by the federal government, although clients are required to be low-income and must have limited or no insurance coverage. ADAP decisions on their individual program income eligibility level reflect budget conditions within a state and the size of the population living with HIV needing services. As a result of these factors, income eligibility levels for ADAPs vary widely across the country, ranging from a low of 200% FPL in four states (Idaho, Iowa, Puerto Rico, Texas) to 500% FPL or more in ten states (Colorado, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Jersey, Pennsylvania, South Carolina, Vermont, and Wyoming).

In addition to income eligibility criteria, many ADAPs use other criteria for eligibility. All ADAP enrollees must be residents of the state in which they are seeking medication, and some ADAPs require documentation of residency. Three ADAPs reported using asset limit criteria and 30 ADAPs report requiring on-going or as needed case management.

9 https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html

10 https://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html

11 https://www.cdc.gov/hiv/group/gender/men/index.html

12 https://www.cdc.gov/hiv/group/gender/women/index.html

  View Larger

Chart 16

ADAP Clients Served, by Demographic, Calendar Year 2015

ADAP Clients Served, by Demographic, Calendar Year 2015

  View Larger

Chart 17

ADAP Clients Served Calendar Year 2015, by Race/Ethnicity

ADAP Clients Served Calendar Year 2015, by Race/Ethnicity

  View Larger

Chart 18

ADAP Clients Served Calendar Year 2015, by Income

ADAP Clients Served Calendar Year 2015, by Income

Table 16

State / Territory Calendar Year 2015 Clients Served Non-Hispanic Black/African American Non-Hispanic White Hispanic Asian Native Hawaiian/Pacific Islander American Indian/Alaskan Native Multi-Racial Other Unknown
Alabama 2,697 66% 24% 4% 0.2% 0.1% 0.1% 5% 0% 0%
Alaska 137 2% 53% 12% 5% 6% 22% 0% 0% 0%
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona 2,116 10% 40% 41% 2% 0.05% 2% 5% 0% 0%
Arkansas 643 35% 58% 5% 0.2% 0.2% 0.3% 0.3% 0.2% 0.2%
California 29,832 11% 37% 45% 4% 0.4% 0.3% 0.4% 0% 2%
Colorado 4,508 20% 50% 24% 2% 0.2% 3% 0% 0% 0%
Connecticut -- -- -- -- -- -- -- -- -- --
Delaware 1,284 63% 29% 7% 0.1% 0% 0% 1% 0% 0%
District of Columbia 1,140 65% 15% 16% 1% 0.1% 0.4% 0% 0% 3%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- --
Florida 20,903 42% 27% 29% 1% 0.1% 0.1% 0.3% 1% 0%
Georgia 9,495 67% 18% 8% 1% 0.1% 0.1% 1% 0.04% 5%
Guam -- -- -- -- -- -- -- -- -- --
Hawaii 371 5% 51% 6% 17% 10% 1% 11% 0% 0.3%
Idaho 233 8% 69% 19% 2% 0.4% 1% 1% 0% 0%
Illinois 7,707 39% 29% 27% 2% 0.1% 0.2% 1% 1% 0.1%
Indiana 2,857 34% 51% 8% 3% 0.04% 0.2% 1% 2% 0%
Iowa 459 18% 63% 15% 3% 0% 0.4% 0.4% 0% 0%
Kansas 1,372 29% 51% 17% 1% 0.3% 1% 0% 0% 0%
Kentucky -- -- -- -- -- -- -- -- -- --
Louisiana 6,943 67% 27% 4% 0.4% 0.1% 0.2% 0.04% 0% 0%
Maine 704 19% 72% 5% 1% 0% 1% 3% 0% 0%
Marshall Islands -- -- -- -- -- -- -- -- -- --
Maryland 5,654 69% 16% 6% 0.1% 1% 0.2% 0.2% 0% 8%
Massachusetts 5,945 27% 39% 28% 2% 0.2% 0.3% 1% 2% 0%
Michigan 3,280 43% 44% 7% 1% 0.1% 0.3% 2% 0.2% 1%
Minnesota 1,320 27% 41% 19% 2% 0.2% 1% 1% 8% 0%
Mississippi 2,277 78% 21% 0.3% 0.3% 0% 0% 0% 0% 0%
Missouri 3,713 52% 41% 6% 1% 0.1% 0.4% 0% 0% 0%
Montana 304 4% 80% 6% 0.3% 1% 10% 0% 0% 0%
Nebraska 728 30% 44% 20% 2% 0.4% 2% 1% 0% 0%
Nevada 1,264 16% 37% 37% 3% 2% 1% 1% 0% 4%
New Hampshire 479 15% 64% 15% 1% 0.2% 1% 4% 0% 0.2%
New Jersey 5,718 45% 18% 32% 2% 0.2% 0.1% 2% 0% 1%
New Mexico 474 4% 35% 56% 1% 0.2% 3% 1% 0% 0%
New York 22,916 36% 25% 32% 2% 0.2% 0.4% 0% 0% 5%
North Carolina 8,288 64% 25% 8% 1% 0.1% 1% 0.4% 0% 1%
North Dakota 178 42% 46% 6% 0% 1% 3% 2% 0% 0%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- --
Ohio 4,023 39% 53% 6% 1% 0.05% 0.2% 1% 0% 0%
Oklahoma 1,855 21% 56% 10% 2% 0.2% 5% 6% 0% 0%
Oregon 3,632 6% 64% 16% 2% 1% 2% 5% 5% 0.2%
Pennsylvania 7,656 47% 37% 13% 1% 0.1% 0.2% 0% 1% 0.04%
Puerto Rico 7,988 0% 0% 0% 0.04% 0% 0% 99.96% 0% 0%
Republic of Palau -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- --
South Carolina 5,580 70% 24% 5% 0.3% 0.02% 0.1% 1% 0% 0.2%
South Dakota 272 29% 52% 6% 0.4% 0% 12% 0% 0% 0%
Tennessee 5,535 58% 34% 7% 1% 0.04% 0.2% 0% 1% 0%
Texas 19,414 35% 23% 38% 1% 0.02% 0.2% 0% 0% 2%
Utah 757 0% 0% 0% 0% 0% 0% 0% 0% 100%
Vermont 329 7% 83% 7% 1% 0% 0.3% 2% 0% 0%
Virgin Islands (U.S.) 155 62% 8% 28% 1% 0% 0% 0% 1% 1%
Virginia 6,335 61% 25% 11% 2% 0.1% 1% 0% 0% 1%
Washington 3,786 15% 58% 19% 4% 1% 2% 0.5% 0% 0%
West Virginia 607 17% 80% 2% 0.5% 0.2% 0% 0.2% 0% 0%
Wisconsin 1,514 13% 23% 17% 1% 0.1% 1% 0% 46% 0%
Wyoming 140 10% 68% 15% 1% 0% 6% 1% 0% 0%
Total 225,517 38% 31% 23% 2% 0.2% 1% 4% 1% 2%

Table 17

State / Territory Calendar Year 2015 Clients Served Male Female Transgender Unknown
Alabama 2,697 73% 26% 1% 0.3%
Alaska 137 77% 23% 0% 0%
American Samoa -- -- -- -- --
Arizona 2,116 84% 15% 1% 0%
Arkansas 643 80% 19% 1% 0%
California 29,832 90% 9% 1% 0%
Colorado 4,508 84% 15% 1% 0%
Connecticut -- -- -- -- --
Delaware 1,284 65% 35% 0.3% 0%
District of Columbia 1,140 75% 25% 1% 0%
Federated States of Micronesia -- -- -- -- --
Florida 20,903 76% 23% 1% 0.01%
Georgia 9,495 74% 22% 1% 3%
Guam -- -- -- -- --
Hawaii 371 91% 9% 1% 0%
Idaho 233 82% 17% 1% 0%
Illinois 7,707 82% 17% 1% 0%
Indiana 2,857 80% 19% 1% 0%
Iowa 459 80% 20% 0% 0%
Kansas 1,372 78% 21% 1% 0%
Kentucky -- -- -- -- --
Louisiana 6,943 73% 26% 1% 0%
Maine 704 80% 19% 1% 0%
Marshall Islands -- -- -- -- --
Maryland 5,654 65% 35% 0.2% 0%
Massachusetts 5,945 68% 31% 1% 0.1%
Michigan 3,280 82% 17% 0.4% 0%
Minnesota 1,320 76% 24% 0.2% 0%
Mississippi 2,277 75% 25% 0.4% 0%
Missouri 3,713 81% 18% 1% 0%
Montana 304 85% 15% 0.3% 0%
Nebraska 728 78% 21% 1% 0%
Nevada 1,264 82% 16% 2% 0%
New Hampshire 479 75% 24% 1% 0%
New Jersey 5,718 69% 31% 0.2% 0%
New Mexico 474 91% 9% 0.2% 0%
New York 22,916 77% 23% 0.4% 0%
North Carolina 8,288 73% 26% 1% 0%
North Dakota 178 32% 68% 0% 0%
Northern Mariana Islands -- -- -- -- --
Ohio 4,023 84% 16% 0.4% 0.3%
Oklahoma 1,855 84% 16% 0.1% 0%
Oregon 3,632 88% 12% 1% 0%
Pennsylvania 7,656 77% 22% 1% 0%
Puerto Rico 7,988 64% 36% 0.2% 0%
Republic of Palau -- -- -- -- --
Rhode Island -- -- -- -- --
South Carolina 5,580 73% 26% 1% 0%
South Dakota 272 65% 35% 0% 0%
Tennessee 5,535 81% 19% 1% 0%
Texas 19,414 78% 22% 1% 0%
Utah 757 0% 0% 0% 100%
Vermont 329 77% 23% 0% 0%
Virgin Islands (U.S.) 155 52% 48% 0% 0%
Virginia 6,335 72% 27% 1% 0%
Washington 3,786 85% 14% 1% 0%
West Virginia 607 82% 18% 0.2% 0%
Wisconsin 1,514 82% 16% 1% 0%
Wyoming 140 75% 25% 0% 0%
Total 225,517 78% 21% 1% 0.5%

Table 18

State / Territory Calendar Year 2015 Clients Served ≤12 Years 13-24 Years 25-44 Years 45-64 Years >64 Years Unknown
Alabama 2,697 0% 9% 57% 33% 1% 0%
Alaska 137 0% 2% 37% 58% 2% 1%
American Samoa -- -- -- -- -- -- --
Arizona 2,116 0.05% 3% 37% 52% 7% 0%
Arkansas 643 0% 23% 74% 2% 1% 0%
California 29,832 0% 2% 35% 53% 10% 0%
Colorado 4,508 0.3% 3% 40% 51% 6% 0%
Connecticut -- -- -- -- -- -- --
Delaware 1,284 0.1% 1% 30% 61% 8% 0%
District of Columbia 1,140 0% 2% 37% 54% 8% 0%
Federated States of Micronesia -- -- -- -- -- -- --
Florida 20,903 0.01% 6% 42% 49% 3% 0%
Georgia 9,495 0.01% 5% 51% 42% 2% 0%
Guam -- -- -- -- -- -- --
Hawaii 371 0% 1% 25% 57% 17% 0%
Idaho 233 0% 4% 57% 36% 3% 0%
Illinois 7,707 0.04% 3% 45% 47% 6% 0%
Indiana 2,857 0.1% 4% 47% 44% 4% 0%
Iowa 459 0.2% 3% 44% 49% 4% 0%
Kansas 1,372 3% 4% 42% 49% 3% 0%
Kentucky -- -- -- -- -- -- --
Louisiana 6,943 0% 7% 49% 42% 3% 0%
Maine 704 0.1% 1% 29% 61% 9% 0%
Marshall Islands -- -- -- -- -- -- --
Maryland 5,654 0.1% 1% 26% 55% 17% 0%
Massachusetts 5,945 0.03% 1% 22% 67% 10% 0%
Michigan 3,280 0.3% 2% 36% 53% 8% 0%
Minnesota 1,320 1% 3% 42% 47% 7% 0%
Mississippi 2,277 0% 11% 54% 23% 13% 0%
Missouri 3,713 1% 6% 51% 40% 2% 0%
Montana 304 0% 4% 16% 60% 20% 0%
Nebraska 728 1% 4% 49% 43% 4% 0%
Nevada 1,264 0.4% 4% 40% 50% 6% 0%
New Hampshire 479 0% 1% 25% 66% 7% 1%
New Jersey 5,718 0.1% 5% 40% 51% 4% 0%
New Mexico 474 0.2% 2% 32% 63% 3% 0%
New York 22,916 0.03% 2% 35% 54% 9% 0%
North Carolina 8,288 0.02% 4% 42% 48% 5% 0%
North Dakota 178 1% 4% 46% 46% 3% 0%
Northern Mariana Islands -- -- -- -- -- -- --
Ohio 4,023 0.02% 4% 37% 54% 6% 0%
Oklahoma 1,855 0% 4% 44% 49% 3% 0%
Oregon 3,632 0% 2% 36% 55% 7% 0%
Pennsylvania 7,656 0.04% 3% 35% 54% 8% 0%
Puerto Rico 7,988 0.1% 4% 31% 60% 5% 0%
Republic of Palau -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- --
South Carolina 5,580 0.2% 5% 43% 48% 4% 0%
South Dakota 272 1% 3% 44% 48% 4% 0%
Tennessee 5,535 0.1% 5% 51% 42% 2% 0%
Texas 19,414 0.04% 4% 48% 44% 4% 0%
Utah 757 0% 0% 0% 0% 0% 100%
Vermont 329 0% 2% 24% 63% 10% 0%
Virgin Islands (U.S.) 155 1% 1% 34% 54% 12% 0%
Virginia 6,335 0% 6% 44% 46% 5% 0%
Washington 3,786 0% 1% 32% 59% 8% 0%
West Virginia 607 0% 2% 32% 61% 4% 0%
Wisconsin 1,514 0% 3% 38% 52% 7% 0%
Wyoming 140 3% 3% 34% 56% 5% 0%
Total 225,517 0.1% 4% 40% 50% 6% 0.3%

Table 19

State / Territory Financial Eligibility Calendar Year 2015 Clients Served ≤100% FPL 101-138%1 FPL 139-200% FPL 201-300% FPL 301-400% FPL >401% FPL Unknown
  Full-Pay Medications (Uninsured) ADAP-Funded Insurance Program
Alabama 250% FPL 250% FPL 2,697 70% 11% 12% 5% 1% 0.4% 0%
Alaska 400% FPL 400% FPL 137 45% 13% 19% 22% 1% 0% 0%
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona 400% FPL 400% FPL 2,116 25% 13% 23% 29% 9% 1% 0%
Arkansas 400% FPL 400% FPL 643 46% 15% 21% 12% 6% 0% 0%
California 425% FPL 425% FPL 29,832 39% 9% 19% 19% 11% 2% 0.04%
Colorado 500% FPL 500% FPL 4,508 43% 14% 15% 9% 16% 2% 0%
Connecticut -- -- -- -- -- -- -- -- -- --
Delaware 500% FPL 500% FPL 1,284 49% 12% 14% 16% 7% 3% 0%
District of Columbia 500% FPL 500% FPL 1,140 50% 7% 17% 7% 15% 4% 0%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- --
Florida 400% FPL 400% FPL 20,903 51% 12% 18% 14% 5% 0% 0%
Georgia 300% FPL 300% FPL 9,495 61% 13% 16% 9% 0.3% 0.1% 1%
Guam -- -- -- -- -- -- -- -- -- --
Hawaii 400% FPL 400% FPL 371 25% 21% 33% 17% 5% 0% 0%
Idaho 200% FPL N/A 233 63% 15% 22% 0% 0% 0% 0%
Illinois 300% FPL 500% FPL 7,707 41% 11% 19% 17% 7% 4% 0%
Indiana 300% FPL 300% FPL 2,857 49% 16% 20% 14% 1% 0.1% 0.1%
Iowa 200% FPL 400% FPL 459 23% 9% 26% 30% 11% 1% 0%
Kansas 300% FPL 300% FPL 1,372 46% 13% 18% 20% 2% 1% 0%
Kentucky -- -- -- -- -- -- -- -- -- --
Louisiana 400% FPL 400% FPL 6,943 51% 15% 17% 13% 3% 0% 0.2%
Maine 500% FPL 500% FPL 704 42% 11% 18% 20% 5% 4% 0%
Marshall Islands -- -- -- -- -- -- -- -- -- --
Maryland 500% FPL 500% FPL 5,654 33% 17% 21% 22% 7% 1% 0%
Massachusetts 500% FPL 500% FPL 5,945 48% 11% 14% 14% 9% 6% 0%
Michigan 450% FPL 450% FPL 3,280 22% 15% 25% 21% 10% 3% 5%
Minnesota 400% FPL 400% FPL 1,320 23% 5% 22% 31% 20% 0% 0%
Mississippi 300% FPL 300% FPL 2,277 66% 13% 19% 2% 0% 0% 0%
Missouri 300% FPL 300% FPL 3,713 49% 10% 16% 19% 4% 1% 0%
Montana 430% FPL 430% FPL 304 45% 15% 22% 10% 8% 1% 0%
Nebraska 300% FPL 300% FPL 728 39% 17% 23% 21% 0% 0% 0%
Nevada 400% FPL 400% FPL 1,264 24% 14% 22% 20% 6% 0% 14%
New Hampshire 400% FPL 400% FPL 479 31% 14% 20% 22% 11% 0.4% 1%
New Jersey 500% FPL 500% FPL 5,718 30% 10% 16% 22% 14% 8% 0%
New Mexico 400% FPL 400% FPL 474 22% 9% 32% 27% 10% 0% 0%
New York 435% FPL 435% FPL 22,916 32% 14% 20% 19% 12% 3% 0%
North Carolina 300% FPL 300% FPL 8,288 53% 17% 19% 11% 0% 0% 0%
North Dakota 400% FPL 400% FPL 178 33% 10% 20% 24% 13% 1% 0%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- --
Ohio 300% FPL 300% FPL 4,023 34% 15% 25% 26% 0% 0% 0%
Oklahoma 400% FPL 400% FPL 1,855 42% 16% 19% 10% 13% 0% 0%
Oregon 400% FPL 400% FPL 3,632 46% 15% 16% 15% 6% 2% 0%
Pennsylvania 500% FPL 500% FPL 7,656 29% 11% 16% 20% 13% 10% 0%
Puerto Rico 200% FPL 200% FPL 7,988 97% 0.1% 0.1% 0% 0% 0% 2%
Republic of Palau -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- --
South Carolina 550% FPL 550% FPL 5,580 47% 10% 16% 16% 7% 4% 0%
South Dakota 300% FPL 300% FPL 272 47% 13% 18% 20% 2% 0% 0%
Tennessee 400% FPL 400% FPL 5,535 49% 10% 15% 19% 8% 0% 0.1%
Texas 200% FPL 200% FPL 19,414 56% 16% 27% 1% 0.01% 0.01% 0%
Utah -- -- 757 59% 12% 16% 13% 1% 0.4% 0%
Vermont 500% FPL 500% FPL 329 42% 13% 20% 14% 7% 4% 0%
Virgin Islands (U.S.) 250% FPL 350% FPL 155 63% 13% 11% 8% 1% 3% 1%
Virginia 400% FPL 400% FPL 6,335 57% 11% 15% 11% 5% 0% 1%
Washington 400% FPL 400% FPL 3,786 25% 16% 22% 23% 13% 2% 0%
West Virginia 400% FPL 400% FPL 607 34% 21% 25% 9% 12% 0% 0%
Wisconsin 300% FPL 300% FPL 1,514 26% 26% 11% 34% 0% 0% 2%
Wyoming 80% Area Median Income 500% FPL 140 43% 19% 16% 15% 6% 0% 0%
Total 225,517 46% 12% 18% 15% 7% 2% 0.3%

Table 20

State / Territory Calendar Year 2015 Clients Served HIV/AIDS Risk Category - Injection Drug Use (IDU) HIV/AIDS Risk Category - Men Who Have Sex with Men (MSM) Co-Infection with Hepatitis C (HCV)
  ADAP Able to Report Clients Served with HIV/AIDS Risk Category - IDU ADAP Able to Report Clients Served with HIV/AIDS Risk Category - MSM ADAP Able to Report Clients Served with Co-Infection with Hepatitis C (HCV)
Alabama 2,697 Yes 8% Yes 53% No --
Alaska 137 No -- No -- No --
American Samoa -- -- -- -- -- -- --
Arizona 2,116 Yes 5% Yes 75% Yes 1%
Arkansas 643 No -- No -- No --
California 29,832 No -- No -- No --
Colorado 4,508 No -- No -- No --
Connecticut -- -- -- -- -- -- --
Delaware 1,284 Yes 10% Yes 35% No --
District of Columbia 1,140 No -- No -- No --
Federated States of Micronesia -- -- -- -- -- -- --
Florida 20,903 No -- No -- No --
Georgia 9,495 Yes 1% Yes 10% Yes 0.03%
Guam -- -- -- -- -- -- --
Hawaii 371 No -- Yes 78% No --
Idaho 233 No -- No -- No --
Illinois 7,707 Yes 2% Yes 55% No --
Indiana 2,857 Yes 4% Yes 63% No --
Iowa 459 Yes 10% Yes 61% No --
Kansas 1,372 Yes 4% Yes 59% No --
Kentucky -- -- -- -- -- -- --
Louisiana 6,943 Yes 4% Yes 43% No --
Maine 704 Yes 7% Yes 55% No --
Marshall Islands -- -- -- -- -- -- --
Maryland 5,654 Yes 7% Yes 34% No --
Massachusetts 5,945 Yes 14% Yes 38% No --
Michigan 3,280 Yes 2% Yes 53% Yes 0.4%
Minnesota 1,320 No -- No -- No --
Mississippi 2,277 No -- No -- No --
Missouri 3,713 Yes 3% Yes 62% No --
Montana 304 No -- No -- No --
Nebraska 728 Yes 6% Yes 53% No --
Nevada 1,264 Yes 3% Yes 56% No --
New Hampshire 479 Yes 10% Yes 47% No --
New Jersey 5,718 No -- No -- Yes 1%
New Mexico 474 Yes 7% Yes 76% No --
New York 22,916 No -- No -- No --
North Carolina 8,288 No -- No -- No --
North Dakota 178 Yes 7% Yes 46% Yes 4%
Northern Mariana Islands -- -- -- -- -- -- --
Ohio 4,023 Yes 2% Yes 57% No --
Oklahoma 1,855 No -- No -- No --
Oregon 3,632 No -- No -- No --
Pennsylvania 7,656 No -- No -- No --
Puerto Rico 7,988 Yes 11% Yes 18% Yes 0.1%
Republic of Palau -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- --
South Carolina 5,580 No -- No -- No --
South Dakota 272 Yes 13% Yes 32% Yes 11%
Tennessee 5,535 No -- No -- No --
Texas 19,414 No -- No -- No --
Utah 757 No -- No -- No --
Vermont 329 No -- No -- No --
Virgin Islands (U.S.) 155 Yes 6% Yes 19% Yes 0%
Virginia 6,335 Yes 9% Yes 50% No --
Washington 3,786 No -- No -- No --
West Virginia 607 No -- No -- No --
Wisconsin 1,514 No -- No -- No --
Wyoming 140 Yes 46% Yes 24% No --
Total 225,517 25 6% 26 44% 8 0.2%

Table 21

State / Territory Calendar Year 2015 Ryan White Part B Clients Served Including ADAP All Clients Served
  Viral Load ≤200 Viral Load >200 Unknown
Alabama -- -- -- --
Alaska 266 0% 0% 100%
American Samoa -- -- -- --
Arizona 2,757 65% 7% 28%
Arkansas 1,515 84% 13% 2%
California -- -- -- --
Colorado 2,196 0% 0% 100%
Connecticut -- -- -- --
Delaware 1,284 78% 22% 0%
District of Columbia 2,393 57% 14% 30%
Federated States of Micronesia -- -- -- --
Florida 20,943 75% 25% 0%
Georgia 10,114 83% 16% 1%
Guam -- -- -- --
Hawaii 898 72% 11% 16%
Idaho 253 87% 12% 1%
Illinois 4,907 80% 14% 5%
Indiana 2,857 85% 14% 0.1%
Iowa 1,218 82% 12% 6%
Kansas 1,128 84% 16% 0%
Kentucky -- -- -- --
Louisiana 7,985 76% 19% 5%
Maine 629 89% 7% 4%
Marshall Islands -- -- -- --
Maryland 1,606 80% 20% 0%
Massachusetts 5,324 0% 0% 100%
Michigan 2,583 79% 13% 8%
Minnesota 2,100 63% 9% 28%
Mississippi 2,277 57% 9% 35%
Missouri 7,122 84% 16% 0%
Montana 304 88% 12% 0%
Nebraska 821 0% 0% 100%
Nevada 2,142 62% 31% 7%
New Hampshire 479 91% 9% 0%
New Jersey 5,718 61% 34% 5%
New Mexico 1,538 40% 18% 42%
New York 22,916 0% 0% 93%
North Carolina 9,886 69% 13% 17%
North Dakota 229 77% 9% 14%
Northern Mariana Islands -- -- -- --
Ohio 4,795 87% 12% 1%
Oklahoma -- -- -- --
Oregon 1,141 77% 22% 1%
Pennsylvania 14,559 61% 16% 22%
Puerto Rico 7,988 55% 11% 13%
Republic of Palau -- -- -- --
Rhode Island -- -- -- --
South Carolina 8,816 74% 10% 16%
South Dakota 302 77% 20% 3%
Tennessee 6,128 83% 17% 0%
Texas -- -- -- --
Utah -- -- -- --
Vermont 570 -- -- --
Virgin Islands (U.S.) 218 67% 12% 21%
Virginia 5,041 66% 21% 12%
Washington 6,978 62% 18% 20%
West Virginia 1,108 84% 15% 1%
Wisconsin 4,440 60% 9% 31%
Wyoming 140 73% 11% 16%
Total 188,612 60% 14% 24%

Table 22

State / Territory Calendar Year 2015 Clients Served All Clients Served Subset of Calendar Year 2015 Clients Served by Full-Pay Medications Only Full-Pay Medications Only Subset of Calendar Year 2015 Clients Served by ADAP-Funded Insurance Only2 ADAP-Funded Insurance Only2 Subset of Calendar Year 2015 Clients Served by Full-Pay Medications and ADAP-Funded Insurance3 Full-Pay Medications and ADAP-Funded Insurance3
  Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown
Alabama 2,697 80% 15% 5% 1,638 -- -- -- 890 -- -- -- 169 -- -- --
Alaska 137 0% 0% 100% 40 -- -- -- 62 -- -- -- 35 -- -- --
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 2,116 87% 9% 4% 668 82% 13% 4% 1,261 89% 6% 4% 187 85% 11% 4%
Arkansas 643 86% 13% 1% 495 86% 12% 2% 148 84% 16% 0% 0 0% 0% 0%
California 29,832 88% 12% 0% 13,440 83% 17% 0.01% 16,392 92% 8% 0% 0 0% 0% 0%
Colorado 4,508 16% 2% 82% 338 -- -- -- 3,687 -- -- -- 483 -- -- --
Connecticut -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Delaware 1,284 78% 22% 0% 0 -- -- -- 0 -- -- -- 1,284 -- -- --
District of Columbia 1,140 58% 13% 29% 637 76% 19% 5% 282 0% 0% 100% 221 83% 12% 5%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 20,903 85% 15% 0% 15,395 82% 18% 0% 2,557 96% 4% 0% 2,951 93% 7% 0%
Georgia 9,495 69% 16% 15% 8,951 68% 16% 16% 544 87% 6% 7% 0 0% 0% 0%
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 371 82% 5% 13% 90 82% 4% 13% 249 82% 5% 13% 32 78% 3% 19%
Idaho 233 88% 12% 0% 233 88% 12% 0% 0 0% 0% 0% 0 0% 0% 0%
Illinois 7,707 90% 10% 0% 3,996 87% 13% 0% 2,235 94% 6% 0% 1,476 94% 6% 0%
Indiana 2,857 85% 14% 0% 314 -- -- -- 1,542 -- -- -- 1,001 -- -- --
Iowa 459 89% 5% 4% 89 83% 9% 8% 280 89% 7% 4% 90 93% 6% 1%
Kansas 1,372 86% 11% 0% 183 77% 23% 0% 1,007 88% 12% 0% 182 82% 18% 0%
Kentucky -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Louisiana 6,943 79% 17% 4% 1,902 70% 27% 4% 3,711 83% 13% 4% 1,330 82% 16% 2%
Maine 704 85% 7% 8% 38 68% 29% 3% 594 85% 6% 9% 72 92% 4% 4%
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 5,654 86% 13% 0.4% 924 77% 21% 2% 260 87% 13% 0% 4,470 88% 12% 0.1%
Massachusetts 5,945 91% 9% 0% 224 78% 22% 0% 5,717 92% 8% 0.03% 4 100% 0% 0%
Michigan 3,280 88% 7% 5% 14 86% 0% 14% 926 82% 10% 8% 2,340 90% 6% 4%
Minnesota 1,320 84% 10% 6% 316 72% 20% 8% 126 79% 14% 7% 878 90% 6% 5%
Mississippi 2,277 0% 0% 100% 2,277 -- -- -- 0 -- -- -- 0 -- -- --
Missouri 3,713 83% 17% 0% 947 67% 33% 0% 1,947 90% 10% 0% 819 86% 14% 0%
Montana 304 85% 15% 0% 37 -- -- -- 119 -- -- -- 148 -- -- --
Nebraska 728 80% 11% 9% 233 65% 19% 16% 368 86% 8% 5% 127 86% 6% 8%
Nevada 1,264 67% 9% 25% 485 -- -- -- 639 -- -- -- 140 -- -- --
New Hampshire 479 91% 9% 0% 104 -- -- -- 129 -- -- -- 246 -- -- --
New Jersey 5,718 61% 34% 5% 3,353 -- -- -- 778 -- -- -- 1,587 -- -- --
New Mexico 474 92% 8% 0% 27 78% 19% 0% 424 94% 6% 0% 23 83% 22% 0%
New York 22,916 89% 9% 1% 0 -- -- -- 0 -- -- -- 22,916 -- -- --
North Carolina 8,288 83% 17% 0% 6,600 80% 20% 0% 1,363 93% 7% 0% 325 88% 12% 0%
North Dakota 178 80% 8% 12% 44 61% 18% 20% 54 87% 6% 7% 80 86% 4% 10%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 4,023 89% 11% 1% 883 79% 19% 2% 2,331 91% 8% 0.3% 809 90% 9% 1%
Oklahoma 1,855 89% 8% 2% 214 -- -- -- 1,315 -- -- -- 326 -- -- --
Oregon 3,632 89% 10% 1% 5 -- -- -- 3,446 -- -- -- 181 -- -- --
Pennsylvania 7,656 66% 10% 24% 3,955 62% 13% 25% 1,485 70% 8% 22% 2,216 71% 6% 22%
Puerto Rico 7,988 80% 14% 6% 7,571 80% 15% 5% 368 77% 7% 17% 49 84% 12% 4%
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
South Carolina 5,580 83% 15% 2% 2,407 75% 23% 2% 1,924 91% 8% 1% 1,249 88% 11% 1%
South Dakota 272 85% 15% 0% 272 -- -- -- 0 -- -- -- 0 -- -- --
Tennessee 5,535 75% 13% 12% 1,419 -- -- -- 4,116 -- -- -- 0 -- -- --
Texas 19,414 53% 47% 0.01% 16,853 52% 48% 0% 2,310 59% 41% 0.1% 251 61% 39% 0%
Utah 757 32% 5% 63% 294 52% 12% 36% 334 0% 0% 100% 129 67% 5% 29%
Vermont 329 0% 0% 100% 2 -- -- -- 327 -- -- -- 0 -- -- --
Virgin Islands (U.S.) 155 83% 17% 0% 119 84% 16% 0% 36 78% 22% 0% 0 0% 0% 0%
Virginia 6,335 59% 23% 18% 1,975 48% 39% 13% 3,078 63% 14% 24% 1,282 68% 18% 14%
Washington 3,786 88% 7% 4% 628 -- -- -- 625 -- -- -- 2,533 -- -- --
West Virginia 607 91% 7% 2% 108 -- -- -- 333 -- -- -- 166 -- -- --
Wisconsin 1,514 69% 5% 26% 653 -- -- -- 200 -- -- -- 661 -- -- --
Wyoming 140 73% 11% 16% 28 43% 32% 25% 112 80% 6% 13% 0 0% 0% 0%
Total 225,517 77% 16% 7% 101,418 72% 24% 4% 70,631 86% 10% 4% 53,468 86% 10% 4%

Table 23

State / Territory Calendar Year 2015 Clients Served with HIV/AIDS Risk Category of Men Who Have Sex with Men (MSM) Calendar Year 2015 Clients Served with HIV/AIDS Risk Category of Men Who Have Sex with Men (MSM) Calendar Year 2015 Clients Served - Non-Hispanic Black / African American Calendar Year 2015 Clients Served - Non-Hispanic Black / African American Calendar Year 2015 Clients Served - Non-Hispanic White Calendar Year 2015 Clients Served - Non-Hispanic White Calendar Year 2015 Clients Served - Hispanic Calendar Year 2015 Clients Served - Hispanic Calendar Year 2015 Clients Served - Asian Calendar Year 2015 Clients Served - Asian Calendar Year 2015 Clients Served - Native Hawaiian / Pacific Islander Calendar Year 2015 Clients Served - Native Hawaiian / Pacific Islander Calendar Year 2015 Clients Served - American Indian / Alaskan Native Calendar Year 2015 Clients Served - American Indian / Alaskan Native Calendar Year 2015 Clients Served - Multi-Racial Calendar Year 2015 Clients Served - Multi-Racial Calendar Year 2015 Clients Served - Other Calendar Year 2015 Clients Served - Other Calendar Year 2015 Clients Served - Unknown Race / Ethnicity Calendar Year 2015 Clients Served - Unknown Race / Ethnicity Calendar Year 2015 Clients Served ≤100% FPL Calendar Year 2015 Clients Served ≤100% FPL Calendar Year 2015 Clients Served 101 - 138% FPL Calendar Year 2015 Clients Served 101 - 138% FPL Calendar Year 2015 Clients Served ≥139% FPL Calendar Year 2015 Clients Served ≥139% FPL Calendar Year 2015 Clients Served Unknown Income Calendar Year 2015 Clients Served Unknown Income
  Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown
Alabama 1,416 81% 15% 4% 1,776 78% 17% 5% 654 83% 12% 5% 116 86% 7% 7% 5 100% 0% 0% 2 100% 0% 0% 2 0% 100% 0% 142 85% 8% 6% 0 0% 0% 0% 0 0% 0% 0% 1,901 77% 17% 6% 301 86% 9% 5% 495 87% 10% 3% 0 0% 0% 0%
Arizona 1,583 87% 8% 4% 205 85% 11% 4% 846 88% 6% 5% 875 87% 10% 3% 39 79% 8% 13% 1 100% 0% 0% 37 65% 22% 14% 113 87% 10% 4% 0 0% 0% 0% 0 0% 0% 0% 529 82% 12% 5% 272 84% 11% 4% 1,314 89% 7% 4% 0 0% 0% 0%
Georgia 996 62% 38% 0% 6,325 70% 18% 11% 1,684 75% 12% 12% 796 83% 10% 7% 74 78% 8% 14% 5 80% 0% 20% 9 67% 33% 0% 116 79% 14% 7% 4 100% 0% 0% 482 10% 2% 88% 5,818 67% 17% 16% 1,209 73% 15% 12% 2,397 75% 12% 13% 71 8% 4% 87%
Hawaii 288 83% 5% 13% 17 65% 12% 24% 190 82% 5% 14% 23 87% 0% 13% 62 85% 0% 15% 36 78% 6% 17% 2 100% 0% 0% 40 85% 10% 5% 0 0% 0% 0% 1 100% 0% 0% 92 80% 2% 17% 79 84% 5% 11% 200 82% 6% 13% 0 0% 0% 0%
Illinois 4,230 91% 9% 0% 3,032 86% 14% 0% 2,259 93% 7% 0% 2,103 92% 8% 0% 145 93% 7% 0% 8 100% 0% 0% 17 88% 12% 0% 66 91% 9% 0% 71 89% 11% 0% 6 83% 17% 0% 3,194 86% 14% 0% 885 91% 9% 0% 3,628 93% 7% 0% 0 0% 0% 0%
Indiana 1,803 86% 13% 0.30% 968 80% 19% 1% 1,467 88% 12% 0% 236 87% 13% 0% 75 84% 12% 0% 1 100% 0% 0% 7 86% 14% 0% 39 82% 13% 5% 67 97% 3% 0% 0 0% 0% 0% 1,388 80% 19% 1% 459 88% 12% 0.20% 1,006 90% 9% 0.50% 4 0% 0% 100%
Iowa 281 89% 6% 5% 81 89% 7% 4% 289 89% 6% 5% 70 87% 9% 4% 15 87% 13% 0% 0 0% 0% 0% 2 50% 50% 0% 2 100% 0% 0% 0 0% 0% 0% 0 0% 0% 0% 104 85% 9% 7% 43 86% 9% 5% 312 90% 6% 4% 0 0% 0% 0%
Louisiana 3,002 81% 15% 4% 4,676 76% 20% 3% 1,909 84% 11% 5% 305 86% 11% 3% 25 96% 0% 4% 9 89% 11% 0% 16 75% 19% 6% 3 67% 0% 33% 0 0% 0% 0% 0 0% 0% 0% 3,532 74% 22% 4% 1,049 82% 15% 4% 2,345 86% 12% 2% 17 82% 12% 6%
Maine 390 82% 7% 11% 133 89% 9% 2% 504 82% 7% 11% 34 74% 9% 18% 5 80% 20% 0% 0 0% 0% 0% 5 100% 0% 0% 23 87% 13% 0% 0 0% 0% 0% 0 0% 0% 0% 295 81% 13% 6% 80 86% 5% 9% 329 84% 4% 11% 0 0% 0% 0%
Maryland 1,930 86% 14% 0.30% 3,900 86% 14% 0.40% 902 91% 8% 0.30% 316 89% 10% 1% 8 88% 13% 0% 47 89% 9% 2% 11 100% 0% 0% 9 89% 11% 0% 0 0% 0% 0% 461 83% 16% 1% 1,852 84% 15% 1% 954 87% 13% 0% 2,848 88% 12% 0.20% 0 0% 0% 0%
Massachusetts 2,276 93% 7% 0% 1,626 90% 10% 0% 2,304 93% 7% 0% 1,668 90% 10% 0% 111 96% 4% 0% 10 90% 10% 0% 17 88% 12% 0% 63 89% 11% 0% 146 0% 1% 99% 0 0% 0% 0% 2,827 88% 12% 0% 644 91% 9% 0% 2,474 94% 6% 0.10% 0 0% 0% 0%
Michigan 1,745 89% 7% 4% 1,420 85% 10% 5% 1,455 90% 5% 5% 230 89% 7% 4% 49 94% 6% 0% 4 100% 0% 0% 11 91% 0% 9% 65 89% 8% 3% 7 100% 0% 0% 39 51% 5% 44% 717 83% 12% 6% 483 86% 9% 6% 1,920 94% 6% 0.20% 160 7% 1% 93%
Missouri 2,320 84% 16% 0% 1,933 77% 23% 0% 1,527 89% 11% 0% 212 89% 11% 0% 21 86% 14% 0% 5 100% 0% 0% 15 100% 0% 0% 0 0% 0% 0% 0 0% 0% 0% 0 0% 0% 0% 1,824 77% 23% 0% 383 84% 16% 0% 1,506 90% 10% 0% 0 0% 0% 0%
Nebraska 384 79% 12% 9% 220 77% 11% 12% 323 81% 12% 7% 147 85% 7% 8% 18 56% 11% 33% 3 100% 0% 0% 13 69% 23% 8% 4 50% 25% 25% 0 0% 0% 0% 0 0% 0% 0% 281 73% 16% 11% 126 78% 12% 10% 321 86% 7% 7% 0 0% 0% 0%
New Mexico 361 95% 5% 0% 21 100% 0% 0% 167 96% 4% 0% 264 90% 10% 0% 4 50% 50% 0% 1 100% 0% 0% 14 93% 7% 0% 3 100% 0% 0% 0 0% 0% 0% 0 0% 0% 0% 102 90% 10% 0% 44 93% 7% 0% 328 93% 7% 0% 0 0% 0% 0%
North Dakota 81 77% 9% 15% 75 84% 8% 8% 82 74% 10% 16% 10 90% 0% 10% 0 0% 0% 0% 1 100% 0% 0% 6 100% 0% 0% 4 75% 0% 25% 0 0% 0% 0% 0 0% 0% 0% 59 76% 8% 15% 17 88% 12% 0% 102 81% 7% 12% 0 0% 0% 0%
Ohio 2,288 88% 11% 1% 1,581 85% 15% 1% 2,124 91% 8% 1% 237 89% 10% 1% 24 100% 0% 0% 2 100% 0% 0% 8 88% 0% 13% 47 85% 13% 2% 0 0% 0% 0% 0 0% 0% 0% 1,369 84% 15% 2% 600 91% 9% 0.20% 2,054 91% 9% 0.30% 0 0% 0% 0%
Puerto Rico 1,447 85% 11% 4% 0 0% 0% 0% 0 0% 0% 0% 0 0% 0% 0% 3 100% 0% 0% 0 0% 0% 0% 0 0% 0% 0% 7985 80% 15% 6% 0 0% 0% 0% 0 0% 0% 0% 7,785 81% 14% 5% 10 90% 10% 0% 9 100% 0% 0% 184 36% 16% 48%
Virginia 3,184 62% 23% 15% 3,864 56% 25% 18% 1,566 63% 18% 20% 684 68% 20% 12% 111 68% 21% 12% 9 89% 0% 11% 52 65% 17% 17% 0 0% 0% 0% 0 0% 0% 0% 49 31% 14% 55% 3,608 57% 26% 17% 717 59% 22% 20% 1,960 64% 17% 18% 50 30% 16% 54%
Wyoming 34 144% 21% 26% 14 57% 7% 36% 95 73% 15% 13% 21 86% 0% 14% 1 100% 0% 0% 0 0% 0% 0% 8 63% 13% 25% 1 100% 0% 0% 0 0% 0% 0% 0 0% 0% 0% 60 60% 17% 23% 27 81% 7% 11% 53 79% 8% 13% 0 0% 0% 0%
Total 30,039 86% 14% 4% 31,867 77% 9% 3% 20,347 86% 10% 5% 8,347 87% 10% 3% 795 85% 9% 6% 144 88% 6% 6% 252 78% 14% 8% 8725 80% 14% 5% 295 47% 4% 49% 1,038 45% 9% 45% 37,337 77% 17% 6% 8,382 83% 13% 5% 25,601 87% 9% 4% 486 23% 9% 68%

Table 24

State / Territory Ryan White Part B ADAP
  Financial Eligibility1 Asset Limits State Residency Requirement Case Management Requirement Other Requirement Financial Eligibility1 Calculation Basis
  Part B Core Medical Services Part B Support Services Part B Core Medical Services Part B Support Services Part B Core Medical Services Part B Support Services Part B Core Medical Services Part B Support Services Full-Pay Medications (Uninsured) ADAP-Funded Insurance Program Gross Income Modified Adjusted Gross Income (MAGI) Net Income Individual Income Household Income Family Income
Alabama 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 250% FPL 250% FPL Yes No No Yes Yes Yes
Alaska 400% FPL 400% FPL No No Individual must be a state resident for at least 30 days (proof required) Individual must be a state resident for at least 30 days (proof required) Ongoing Ongoing Yes 400% FPL 400% FPL Yes Yes No Yes Yes No
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed Yes 400% FPL 400% FPL No Yes No No No No
Arkansas 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL Yes No No Yes Yes Yes
California -- -- -- -- -- -- -- -- -- 425% FPL 425% FPL No No No Yes No No
Colorado 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No 500% FPL 500% FPL No Yes No Yes No Yes
Connecticut -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Delaware 500% FPL 500% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing Yes 500% FPL 500% FPL No Yes No No No No
District of Columbia 500% FPL 500% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 500% FPL 500% FPL Yes No No No Yes No
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No 400% FPL 400% FPL Yes No No Yes Yes Yes
Georgia 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 300% FPL 300% FPL No Yes No No No No
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL Yes No No No No Yes
Idaho 200% FPL 200% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 200% FPL N/A Yes No No No No No
Illinois 500% FPL 500% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed Yes 300% FPL 500% FPL No Yes No No Yes No
Indiana 300% FPL None No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing As needed No 300% FPL 300% FPL No Yes No No No No
Iowa 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 200% FPL 400% FPL Yes No No No Yes No
Kansas 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 300% FPL 300% FPL Yes No No Yes Yes No
Kentucky -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Louisiana 300% FPL 300% FPL No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) None None No 400% FPL 400% FPL Yes No No No No No
Maine Other 2 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 500% FPL 500% FPL Yes No No No No Yes
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 500% FPL 500% FPL Yes No No No Yes No
Massachusetts 500% FPL 500% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 500% FPL 500% FPL Yes No No No No No
Michigan 450% FPL 450% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 450% FPL 450% FPL Yes No No No No Yes
Minnesota 300% FPL Other 3 No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 400% FPL 400% FPL No Yes No No No No
Mississippi 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No 300% FPL 300% FPL Yes Yes No No Yes No
Missouri 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 300% FPL 300% FPL Yes No No Yes No Yes
Montana 430% FPL 430% FPL No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) As needed As needed Yes 430% FPL 430% FPL Yes Yes No Yes Yes Yes
Nebraska 200% FPL 200% FPL No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) Ongoing Ongoing No 300% FPL 300% FPL No Yes No No Yes No
Nevada 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 400% FPL 400% FPL No Yes No No No No
New Hampshire 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL Yes No No No Yes No
New Jersey 500% FPL 500% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Initial Initial No 500% FPL 500% FPL No Yes No No No No
New Mexico 400% FPL 400% FPL Yes Yes Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL Yes No No No Yes No
New York 435% FPL 435% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 435% FPL 435% FPL Yes No No Yes Yes Yes
North Carolina 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 300% FPL 300% FPL Yes No Yes No No Yes
North Dakota 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL Yes No No No No No
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No 300% FPL 300% FPL Yes No No No No No
Oklahoma 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL Yes Yes No Yes Yes Yes
Oregon 250% FPL 250% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL Yes No Yes Yes No Yes
Pennsylvania 500% FPL 500% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No 500% FPL 500% FPL Yes No No No No No
Puerto Rico 200% FPL 200% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 200% FPL 200% FPL No No Yes Yes Yes No
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
South Carolina 550% FPL 550% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 550% FPL 550% FPL No Yes No No No No
South Dakota 300% FPL 300% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 300% FPL 300% FPL Yes No No No No No
Tennessee 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL No Yes No No No No
Texas 200% FPL 200% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 200% FPL 200% FPL No Yes No No No No
Utah -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Vermont 500% FPL 500% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 500% FPL 500% FPL No Yes No No No No
Virgin Islands (U.S.) 300% FPL 300% FPL No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) Ongoing Ongoing No 250% FPL 350% FPL Yes No No Yes No No
Virginia 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 400% FPL 400% FPL Yes Yes No No Yes No
Washington 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None Ongoing No 400% FPL 400% FPL Yes Yes No No No Yes
West Virginia 400% FPL 400% FPL No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 400% FPL 400% FPL No Yes No No No No
Wisconsin N/A N/A No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No 300% FPL 300% FPL Yes No No No Yes No
Wyoming 80% Area Median Income 80% Area Median Income No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No 80% Area Median Income 500% FPL No Yes No No Yes No
Total 1 1 48 48 33 34 5

Table 25

State / Territory Asset Limits State Residency Requirement Case Management Requirement Other Requirement
  Full-Pay Medications (Uninsured) ADAP-Funded Insurance Program Full-Pay Medications (Uninsured) ADAP-Funded Insurance Program Full-Pay Medications (Uninsured) ADAP-Funded Insurance Program
Alabama No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Alaska No No Individual must be a state resident for at least 30 days (proof required) Individual must be a state resident for at least 30 days (proof required) Ongoing Ongoing Prescription for antiretrovirals (ARVs)
American Samoa -- -- -- -- -- -- --
Arizona No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No
Arkansas No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
California No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Colorado No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed Ongoing No
Connecticut -- -- -- -- -- -- --
Delaware No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
District of Columbia No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Federated States of Micronesia -- -- -- -- -- -- --
Florida No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No
Georgia $10,000 $10,000 Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Guam -- -- -- -- -- -- --
Hawaii No No Individual must provide documented proof of state residency 2 Individual must provide documented proof of state residency 2 Ongoing Ongoing No
Idaho No No Individual must provide documented proof of state residency N/A Ongoing N/A No
Illinois No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Indiana No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Iowa No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Kansas No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Kentucky -- -- -- -- -- -- --
Louisiana No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) None None No
Maine No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Marshall Islands -- -- -- -- -- -- --
Maryland No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Massachusetts No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Michigan No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Minnesota No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) None None No
Mississippi No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No
Missouri No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Montana No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) As needed As needed No
Nebraska No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) None None No
Nevada No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
New Hampshire No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
New Jersey No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No
New Mexico $9,999 $9,999 Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
New York $25,0003 $25,0003 Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
North Carolina No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
North Dakota No No Individual must provide documented proof of state residency4 Individual must provide documented proof of state residency4 Ongoing Ongoing No
Northern Mariana Islands -- -- -- -- -- -- --
Ohio No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No
Oklahoma No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Oregon No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing As needed No
Pennsylvania No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No
Puerto Rico No No Individual must be a state resident for at least 60 days (proof required) Individual must be a state resident for at least 60 days (proof required) Ongoing Ongoing No
Republic of Palau -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- --
South Carolina No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency As needed As needed No
South Dakota No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Tennessee No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Texas No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None CD4 count and viral load
Utah -- -- -- -- -- -- --
Vermont No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Virgin Islands (U.S.) No No Individual must identify as a state resident (no proof required) Individual must identify as a state resident (no proof required) Ongoing Ongoing No
Virginia No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Washington No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
West Virginia No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Wisconsin No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency None None No
Wyoming No No Individual must provide documented proof of state residency Individual must provide documented proof of state residency Ongoing Ongoing No
Total 3 3 49 48 30 30 2

Table 26

State / Territory ADAP Client Enrollment Processes Form ADAP Applications Accepted
  Intake at Local ASOs, CBOs, clinical settings, and Local Health Department1 Intake at ADAP Office Application Over the Phone Faxed Application Mail In Application Other State Programs2 Other Enrollment Processses Paper3 Electronic or Online
Alabama Yes No No No No No No Yes No
Alaska Yes Yes Yes Yes No No No Yes No
American Samoa -- -- -- -- -- -- -- -- --
Arizona Yes Yes Yes Yes Yes Yes No Yes Yes
Arkansas Yes No Yes Yes Yes No No Yes No
California No No No No No No Yes Yes Yes
Colorado Yes Yes No Yes Yes No No Yes Yes
Connecticut -- -- -- -- -- -- -- -- --
Delaware Yes No No No No No No Yes No
District of Columbia Yes Yes No Yes Yes No No Yes No
Federated States of Micronesia -- -- -- -- -- -- -- -- --
Florida Yes Yes No No No No No Yes No
Georgia Yes No No No Yes No No Yes Yes
Guam -- -- -- -- -- -- -- -- --
Hawaii Yes No No No No No No Yes No
Idaho Yes No No No No No No Yes No
Illinois Yes No Yes Yes Yes No No Yes Yes
Indiana Yes No No No No No No Yes No
Iowa Yes No No No No No No Yes No
Kansas Yes No No No No No No Yes No
Kentucky -- -- -- -- -- -- -- -- --
Louisiana Yes Yes No Yes Yes No No Yes No
Maine Yes No No Yes Yes No No Yes No
Marshall Islands -- -- -- -- -- -- -- -- --
Maryland Yes Yes No Yes Yes No No Yes No
Massachusetts Yes Yes Yes Yes Yes No No Yes No
Michigan Yes No No Yes Yes No No Yes No
Minnesota Yes No No Yes Yes No No Yes Yes
Mississippi Yes No No Yes Yes No No Yes Yes
Missouri Yes No No No No No No No Yes
Montana Yes No No Yes Yes No No Yes No
Nebraska Yes Yes No Yes Yes Yes No Yes No
Nevada Yes No Yes Yes Yes No No Yes Yes
New Hampshire Yes No No Yes Yes No No Yes No
New Jersey Yes No No Yes Yes No No Yes No
New Mexico Yes No No Yes Yes No No Yes No
New York No No No Yes Yes No No Yes No
North Carolina No No No Yes Yes No No Yes No
North Dakota Yes No No No No No No Yes No
Northern Mariana Islands -- -- -- -- -- -- -- -- --
Ohio No Yes No No No No No Yes Yes
Oklahoma Yes No No No No Yes No No Yes
Oregon No Yes No Yes Yes No Yes Yes Yes
Pennsylvania No No No Yes Yes No No Yes Yes
Puerto Rico Yes No No Yes No Yes Yes Yes Yes
Republic of Palau -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- --
South Carolina Yes No No Yes Yes Yes No Yes Yes
South Dakota Yes Yes No No No No No Yes No
Tennessee Yes No No No No No No No Yes
Texas No No No Yes Yes No No Yes No
Utah -- -- -- -- -- -- -- -- --
Vermont No Yes No Yes Yes No No Yes No
Virgin Islands (U.S.) Yes No No Yes No No No Yes No
Virginia No Yes Yes Yes Yes No No Yes No
Washington No No No Yes Yes No No Yes No
West Virginia Yes Yes No No Yes Yes No Yes No
Wisconsin Yes Yes No Yes Yes No No Yes No
Wyoming No No No Yes Yes No Yes Yes Yes
Total 38 16 7 32 31 6 4 46 17

Table 27

State / Territory Client Cost-Sharing Overall Program Enrollment Cap Drug Specific Enrollment Cap Maximum Cost Per Client Maximum Number of Prescriptions Per Client Per Month Drug(s) with Prior Authorization2 Other
  Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance
Alabama No No No No No No No Yes No No Yes No No No
Alaska No No No No No No No No No No No No No No
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona No No No No No No No No No No Yes Yes No No
Arkansas No No No No No No No No No No Yes Yes No No
California Yes Yes No No No No No No No No Yes Yes No No
Colorado No No No No No No No No No No No No No No
Connecticut -- -- -- -- -- -- -- -- -- -- -- -- -- --
Delaware No No No No No No No No No No Yes Yes No No
District of Columbia No No No No No No Yes Yes No No Yes Yes No No
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida No No No No No No No No No No Yes Yes No No
Georgia No No No No No No No Yes No No Yes No No No
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii No No No No Yes Yes No No No No No No No No
Idaho No N/A Yes N/A Yes N/A No N/A No N/A Yes N/A No N/A
Illinois No No No No Yes No Yes Yes Yes Yes Yes No No No
Indiana No No Yes Yes No No No No No No No Yes No No
Iowa No No No No No No No No No No No No No No
Kansas No No No No No No No No No No Yes No No No
Kentucky -- -- -- -- -- -- -- -- -- -- -- -- -- --
Louisiana No No No No No Yes No No No No No Yes No No
Maine No No No No No No No No No No Yes Yes No No
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland No No No No No No No No No No Yes Yes No No
Massachusetts No No No No No No No No No No No No No No
Michigan No No No No No No No No No No Yes Yes No No
Minnesota No No No No No No No No No No Yes Yes No No
Mississippi No No No No No No No No No No No No No No
Missouri No No No No No No No No No No No No No No
Montana No No No No No No No No No No Yes Yes No No
Nebraska No No No No No No No No No No Yes Yes No No
Nevada No No No No No No No No No No No No No No
New Hampshire No No No No No No No No No No Yes Yes No No
New Jersey No No No No No No No No No No No No No No
New Mexico No Yes No No No No No No No No Yes No No No
New York No No No No No No No No No No No No No No
North Carolina No No No No No No No No No No No No No No
North Dakota No No No No No No No No No No No No No No
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio No No No No No No No No No No Yes Yes No No
Oklahoma No No No No No No No No No No No No No No
Oregon No No No No No No No No No No Yes No No No
Pennsylvania No No No No No No No No No No No No Yes No
Puerto Rico No No No No No No No Yes No No Yes Yes No No
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- -- -- --
South Carolina No No No No No No No No No No Yes Yes No No
South Dakota No No No No No No No No No No No No No No
Tennessee No No No No No No No No No No No No No No
Texas No No No No No No No No Yes No No No No No
Utah -- -- -- -- -- -- -- -- -- -- -- -- -- --
Vermont No No No No No No No No No No No No No No
Virgin Islands (U.S.) No No No No No No No No Yes Yes Yes Yes No No
Virginia No No No No No No No No No No No Yes No No
Washington Yes Yes No No No No No No No No Yes Yes No No
West Virginia No No No No No No No No No No Yes Yes No No
Wisconsin No No No No No No No No No No No No No No
Wyoming No No No No No No No No No No Yes Yes No No
Total 2 3 2 1 3 2 2 5 3 2 27 23 1 0

Table 28

State / Territory Mail Order Delivered to Client's Home Mail Order Delivered to Client's Clinic Central Pharmacy Distribution Contract Pharmacy Distribution Retail Pharmacy Distribution Other
  Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance Full-Pay Rx Insurance
Alabama No Yes Yes No Yes No No No No Yes No No
Alaska Yes Yes Yes Yes Yes Yes Yes Yes No No No No
American Samoa -- -- -- -- -- -- -- -- -- -- -- --
Arizona Yes Yes Yes Yes Yes No Yes No No Yes No No
Arkansas Yes Yes No No No No Yes Yes Yes Yes No No
California No No No No No No No No No No Yes Yes
Colorado Yes Yes Yes Yes No No Yes Yes Yes Yes No No
Connecticut -- -- -- -- -- -- -- -- -- -- -- --
Delaware No No No No No No No No Yes Yes No No
District of Columbia Yes Yes No No No No Yes Yes No No No No
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- --
Florida No Yes No Yes Yes No No Yes No Yes No No
Georgia Yes Yes No No No No Yes No Yes Yes No No
Guam -- -- -- -- -- -- -- -- -- -- -- --
Hawaii Yes Yes Yes Yes Yes Yes Yes Yes No No No No
Idaho Yes No No No No No No No Yes No No No
Illinois Yes Yes Yes Yes No No No No No No Yes Yes
Indiana Yes Yes Yes Yes No No No No Yes Yes No No
Iowa Yes Yes Yes Yes Yes Yes Yes Yes No Yes No No
Kansas No No No No No No No No Yes Yes No No
Kentucky -- -- -- -- -- -- -- -- -- -- -- --
Louisiana Yes Yes Yes Yes No No Yes Yes No No No No
Maine Yes Yes No No No No No No Yes Yes No No
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- --
Maryland Yes Yes Yes Yes No No No No Yes Yes No No
Massachusetts No Yes No Yes No No No No Yes Yes No No
Michigan Yes Yes No No No No No No Yes Yes No No
Minnesota Yes Yes No No No No No No Yes Yes No No
Mississippi Yes Yes Yes Yes Yes Yes No No No No No No
Missouri No Yes No Yes No No No No Yes Yes No No
Montana Yes Yes Yes Yes No No Yes Yes No No No No
Nebraska Yes Yes Yes Yes Yes No No Yes No Yes No No
Nevada Yes Yes Yes Yes No No No No Yes Yes Yes Yes
New Hampshire Yes Yes Yes Yes No No No No Yes Yes No No
New Jersey No No No No No No No No Yes Yes No No
New Mexico Yes Yes Yes Yes No No Yes Yes No Yes No No
New York Yes Yes Yes Yes No No No No Yes Yes No No
North Carolina Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No
North Dakota No No No No No No No No Yes Yes No No
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- --
Ohio Yes Yes Yes Yes No No No No No No No No
Oklahoma Yes Yes Yes Yes No No Yes Yes No No No No
Oregon Yes Yes Yes Yes No No Yes Yes No Yes No No
Pennsylvania No No No No No No No No Yes Yes No No
Puerto Rico No No No No Yes No No No No Yes No No
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island -- -- -- -- -- -- -- -- -- -- -- --
South Carolina Yes Yes Yes Yes No No No No No Yes No No
South Dakota Yes Yes No No Yes Yes No No No No No No
Tennessee Yes Yes No Yes No No Yes No No Yes No No
Texas No Yes No No No No No No Yes No No No
Utah -- -- -- -- -- -- -- -- -- -- -- --
Vermont Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No
Virgin Islands (U.S.) Yes No No No No No No No Yes Yes No Yes
Virginia No Yes No Yes Yes No No No No Yes No No
Washington No No No No No No Yes Yes Yes Yes No No
West Virginia Yes Yes No No No No No No Yes Yes No No
Wisconsin Yes Yes No No No No No No Yes Yes No No
Wyoming No No No No No No Yes Yes Yes Yes No No
Total 34 38 23 27 13 7 18 17 27 36 3 4

Table 29

State / Territory Purchasing Mechanism Uses Wholesaler to Purchase Medications Wholesaler Used to Purchase Medications
  Amerisource Bergen Borschow Capital Wholesale Drug Cardinal Droguería Castillo McKesson Morris & Dickson Other
Alabama Dual Yes Yes No No No No No No No
Alaska Direct purchase Yes No No No Yes No No No No
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona Dual Yes No No No Yes No No No No
Arkansas Dual Yes No No No No No No Yes No
California Rebate No N/A N/A N/A N/A N/A N/A N/A N/A
Colorado Dual Yes Yes No No No No No No No
Connecticut -- -- -- -- -- -- -- -- -- --
Delaware Hybrid No N/A N/A N/A N/A N/A N/A N/A N/A