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 CAREAssist - For individuals The AIDS Drug Assistance Program (ADAP) provides access to medications for people infected with HIV. Every state in the United States receives federal funding to support ADAP, although the benefits and eligibility requirements vary state by state. Few individuals are able to afford the cost of medical treatment for HIV, which can average $12,000 per year for one person. Even for people with health insurance, copays for doctors' appointments and medications can add up quickly. ADAP exists to help people afford medical care and treatment to stay healthy.
CAREAssist is Oregon's version of ADAP. CAREAssist helps people living with HIV or AIDS pay for medication and other medical care expenses. We are not health insurance, but we help individuals maintain health insurance by paying for insurance premiums, doctor visit copays and medication copays. It is our hope that by providing CAREAssist services, Oregonians living with HIV/AIDS are empowered to effectively manage their HIV disease and improve their overall health and quality of life.
CAREAssist Member Handbook
Eligibility
To become a member of CAREAssist, you must:
The CAREAssist program is designed for those who need financial help to pay for their HIV medications. This means that when you apply for coverage, we'll have to ask questions about your income and financial resources. How will CAREAssist help me?
CAREAssist can help you pay for health insurance, prescription drugs and doctors visits. The benefits you receive through CAREAssist are dependent upon what Group you are in. CAREAssist decides what group you are in based on your income and what type of health insurance you have. The summary of benefits received by each group can be found below.
Summary of benefitsGroup 1: The target population for this group includes those with income eligibility at less than 200% of the Federal Poverty Level.Group 2: The target population for this group includes those who are on Medicaid (The Oregon Health Plan) or are Veterans Administration (VA) eligible clients. Group 3: The target population for this group includes those who are at 200-300% of the federal poverty level AND with medical insurance. Bridge: Short-term medication and limited medical services access while you are applying for a long-term assistance program, such as OMIP, Medicaid, etc. More information is available on the Bridge program page. Case Management
Some CAREAssist members may also have an HIV case manager. HIV case managers are located throughout the state. They know about the services and programs available in your area to help HIV-positive Oregonians and their families. They can help with information and referrals, adherence to HIV medications, and coordination between your health care providers. Case managers can help determine eligibility for various programs that can assist you. HIV case managers are found at community based organizations, health departments and health clinics.
You may qualify for help with:
All available services depend on current funding levels. They may vary from county to county. Call a local HIV case manager for more information. To find the HIV case manager nearest you, call the Oregon HIV/STD Hotline at 800-777-2437 or visit their website at www.oregonaidshotline.com. Cost Share
A cost-share is required of all members whose income is over 150% of the federal poverty level (FPL) (or about $1,350/month for one person). The cost-share amount is 2% of your family income (before taxes) and is paid monthly. Cost-share bills will start on the first full month of enrollment in CAREAssist. The CAREAssist program will send you a bill for your cost-share every month and payment will be due by the 21st day of that month. If you are more than 1 payment behind, you may be restricted or terminated from the CAREAssist program (See page 25 for information regarding restriction or termination). If your family income is less than 150% of the FPL, you will not have to pay a cost-share.
If you are a CAREAssist member who pays cost-share and your income drops by 25% or more, or falls below 150% of the FPL, you may be eligible to apply for a cost-share adjustment. To apply for an adjustment you must submit a Cost Share Adjustment Request form  along with proof of your change in income (such as a lay-off letter or proof of unemployment). You can also get a cost-share adjustment form by asking your CAREAssist caseworker. If your income increases, you do not need to tell us until your next Client Eligibility Review is due.If you are paying your cost-share in person at our office in Portland, you can take your payment directly to the cashier's office on the 2nd floor. 800 NE Oregon Street,
Suite 200 Portland, OR97232. Payment can be made by check, money order or cash (no coin change is available). Applications & Forms
All CAREAssist forms and instructions, including the application and a Client Eligibility Review (CER) form are available on the Forms & applications page.
Federal Poverty Level Guidelines
CAREAssist uses the Federal Poverty Level guidelines (FPL)
 to determine eligibility based on income. The FPL is based on income and household size. To determine FPL, CAREAssist includes almost all forms of income, including work income/wages/salaries, disability, self-employment income, pension/retirment income, child support and unemployment.Formulary
Formulary is the term used to mean the list of prescription drugs that the CAREAssist program will cover at full price, in the event that your insurance policy does not pay a portion of the cost. Medications not listed on the CAREAssist Formulary must be covered by your insurance policy in order for CAREAssist to assist with the copay. Please view or download the CAREAssist program formulary
for your reference.Pharmacy Information
There are 2 ways you can get your medications:
Mail-orderBy using the mail order pharmacy, all of your medications (both HIV and non-HIV medications) will be conveniently mailed to your home or other location that you choose. If you use the mail-order pharmacy, you will still be able to use a local pharmacy to get urgently needed medication (like a short-term antibiotic).
Or by calling Wellpartner at 1-888-206-1605. Once you have gotten your first prescription, you can register for an online account with Wellpartner. Once you have an online account with WellPartner, you'll be able to request refills online.
In-network pharmacyIf you prefer to use an In-Network Pharmacy, you'll be able to collect your medications at a store-based Pharmacy like Safeway. To find the closest CAREAssist network pharamacy nearest you, visit the Ramsell Public Health Rx website and use the Pharamcy Locator on the right side of the page. Fill in your city, zip code and county, and hit the locate button. For an urgently needed medication (like a short-term antibiotic), you may be able to use a pharmacy that is closer to you. Health Insurance
CAREAssist is happy to help pay premiums for most health care insurance plans, including OMIP, OHP, Medicare, Cobra or employee based insurance programs.
Bridge Program
The CAREAssist Bridge Program provides emergency assistance to help individuals obtain HIV medications for up to 30 days. Assistance provided under this program is intended to help persons meet their medication needs while applying and enrolling in health insurance and CAREAssist. The Bridge Program will assist with payments for limited medical services necessary to allow a primary care provider to prescribe HIV treatments. A limited number of non-HIV related medications may also be covered. An application for the Bridge Program must be completed by an HIV provider. Applications to the Bridge program are available on the Forms & applications page.
A list of Bridge approved medications on the CAREAssist formulary is available on the Public Health website. (All Bridge approved medications are indicated by a "C" in the left-hand column of the document. Smoking Cessation
Did you know that Oregonians living with HIV are 2 1/2 times more likely to smoke than adults statewide? CAREAssist members who smoke or chew tobacco and wish to quit are automatically eligible to receive additional, free services from the Oregon Tobacco Quit Line (1-800-QUIT-NOW or 1-800-784-8669 or online at the Public Health website). CAREAssist members are eligible for a variety of resources, including prescription medication and nicotine replacement to help you quit.
How to get involved
Make your voice heard. Check out the CAREAssist Advisory Group or join us on Facebook and Twitter for HIV related information, events and discussion. Tell us what you think!
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