VA MAP - Eligibility - Disease Prevention

Application Process | VA MAP Service Options | Criteria | Recertification | VA MAP Forms

1-855-362-0658 (phone) / 1-804-864-8050 (fax)

Application Process

To enroll in VA MAP clients must apply through the VA MAP Central Office or through the Virginia Commonwealth University Health Systems (VCUHS) Financial Services (if clients receive services there). Incomplete applications will be returned to provider/sender and no further action will be taken.

- Clients may complete the application themselves and mail and/or fax to the VA MAP Central Office (Fax 1-804-864-8050, Toll Free Fax 1-877-837-2853, Mailing address: Virginia Department of Health, HCS Unit, 1st Floor, James Madison Building, 109 Governor Street, Richmond, VA 23219).
- Clients may call the Medication Eligibility Hotline (1-855-362-0658), and staff will help with the application process. The application will be mailed to the client to sign and provide supporting documents.

The VA MAP application is used to apply for all VA MAP Service Options. Once the client’s application is complete, the VA MAP Central Office staff will determine the service option that best meets the client’s needs.

VA MAP Service Options

1. Direct Medication Assistance Program (Direct MAP): If a client does not have any other coverage for their HIV/AIDS medications, medications can be picked up at any Local Health Department (LHD) or at VCUHS, INOVA, or Carilion Health if they receive services at those sites.

Medication will be shipped from the VDH Central Pharmacy to LHD or alternate medication access site.
Enrolled clients receive a 30-day supply of medication at a time.
Clients may change their pick up site from one site to another by calling the VA MAP Central Office. A letter noting the change will be sent to the client, medical provider, the old access site, the new access site, and pharmacy.
Only VA MAP Formulary medications will be sent to the Local Health Department (LHD) or a predetermined, alternate medication access site.
The VA MAP Central Office staff communicates to LHD VA MAP staff or alternate medication access site as needed about client enrollment, recertification, medication pick-up, labs, and data to ensure ongoing VA MAP services.
VCUHS Financial Services will continue to oversee the initial VA MAP eligibility for their clients picking up VA MAP medications from alternate medication access sites (Ambulatory Care Center (ACC), Hayes E. Willis Clinic or other sites). Recertification at 6 months is handled by the VA MAP Central Office.

2. Medicare Prescription Assistance Program (MPAP): VA MAP clients who are enrolled in Medicare can receive help with monthly premiums and cost shares. Cost shares are medication deductibles and medication co-payments. VA MAP will assist with co-payments for medications on the Medicare formulary. Clients can pick up medications at any pharmacy that accepts their Medicare plan and is within the Ramsell network.

3. Insurance Continuation Assistance Program (ICAP): Individuals with certain private insurance with medication benefits are eligible for VA MAP assistance with their medication co-payments and deductibles if all other qualifications are met. At any point in time a client loses insurance, the client can access medications through the Direct Medication Assistance Program if the client continues to meet VA MAP eligibility criteria.

Medication copayment assistance will cover medications on the VA MAP Formulary and the Ryan White Part B Formulary.

4. Health Insurance Marketplace Assistance Program (HIMAP): VA MAP supports costs for insurance premiums and medication cost shares for clients who enroll in VDH approved plans under the federal Insurance Marketplace under the Affordable Care Act. Please refer to the Affordable Care Act page for approved plans.

Criteria

Residency: VA MAP applicants must live in Virginia and provide proof of residency, which may include.:

Copy of utility bill with client name and current address
Copy of lease or mortgage
Copy of current health insurance /health coverage bill with client’s name and address
Copy of official records/document issued by the state (such as a driver’s license or photo ID card)

Required Medical Documents: HIV Diagnosis Status complete with HIV Medication List [New applications ONLY]

Insurance Coverage: Each applicant will be screened by the VA MAP Central Office to see if they have health insurance. VA MAP may be able to help with client cost shares (medication deductibles and co-payments) under insurance.

Income Criteria: Each VA MAP applicant qualifies if their individual or household income is less than 500% of the Federal Poverty Level (FPL). If the individual or household income changes it is the duty of the client to advise the VA MAP Central Office. Click here for information regarding Financial Eligibility Determination.

Medicaid: Clients must not qualify for or have Medicaid. If a client loses their Medicaid coverage, VA MAP can provide medication assistance.

Services to Veterans: Federal policy gives Veterans (who meet all other VA MAP eligibility criteria) the option of receiving covered medications through VA MAP.

Expedited Enrollment for Pregnant Women and Minors: Pregnant women and minors are prioritized to ensure access to medications and to prevent treatment interruption. Medical providers may contact VA MAP at: 1-855-362-0658 to coordinate.

Recertification

Each client must provide updated information to VDH every six months. Recertifications should be completed through the Provide web portal, at vacare.providecm.net. All supporting documentation can be submitted through this portal, as well.

VA MAP Disnerollment Due to Medicaid Coverage

Under HRSA payer of last resort requirements, program participants must utilize payer sources other than Ryan White HIV/AIDS Program (RWHAP) funds to access medications and other core and support services if they are eligible. If a client currently enrolled in the Virginia Medication Assistance Program (VA MAP) is eligible for Medicaid, that client will be removed from VA MAP services. The purpose of this policy and procedure, the steps of which are posted below, is to transition clients enrolled in Virginia Medicaid out of VA MAP, ensuring reasonable steps are taken to educate clients about using their Medicaid coverage for medication access.

VA MAP Disnerollment Policy – September, 2019

VA MAP Disenrollment Procedure, Due to Medicaid Coverage, and Medicaid Coverage Letter – September, 2019