Glossary
A | C | D | E | F | I | M | P | Q | R | S
A
ADAP: The AIDS Drug Assistance Program. ADAP provides low-income people living with HIV access to medical services and antiretroviral medication. ADAP, also known as Program HH, includes the Drug Assistance Program and the Insurance Assistance Program.
ADAP client: Any person certified as eligible and enrolled in ADAP during the Ryan White budget period of April 1 – March 31 of any specific year. During the budget period, ADAP clients might have:
Advanced Premium Tax Credit (APTC): Federal tax credit that allows clients to reduce the amount they have to pay for the qualified health plan premium. To qualify, the client must file taxes at the end of the year and enroll in a qualified health plan through MNsure. The tax credit is paid to the health plan the client chooses. Clients must pay their portion of the health care premium to the health plan to start and keep coverage.
C
Children’s Health Insurance Program (CHIP): Program that supplements existing federal Medical Assistance funds that provide health care coverage for low-income Minnesota families.
Consolidated Omnibus Budget Reconciliation Act (COBRA): Landmark federal law passed by the U.S. Congress that provides continuing coverage of group health benefits to employees and their families when certain qualifying events occur where such coverage would otherwise be terminated.
Coinsurance: Percent of the cost of medical or prescription drug services that a client is responsible to pay. For example, if the cost of a prescription medication is $100 and the client’s coinsurance is 10%, the client owes $10. If another medication costs $300, the client owes $30. The Drug Assistance Program pays coinsurance for ADAP formulary medications on behalf of eligible clients.
Copayment: Set dollar amounts charged to clients for medical or prescription drug services. For example, a client may have a copayment of $25 per prescription, regardless of the actual cost of the prescription. The Drug Assistance Program pays copayments for ADAP formulary medications on behalf of eligible clients.
D
Deductibles: Set dollar amounts charged to clients for covered health care services before an insurance plan starts to pay. After deductibles are paid, copayment or coinsurance may be charged for covered services, and the insurance company pays the remaining amount. The Drug Assistance Program will pay deductibles, copayments and coinsurance for eligible clients with certain types of public and/or private health insurance.
Drug Assistance Program: Program that covers the cost of antiretroviral and other HIV-related medications or medication deductibles, coinsurance and copayments for eligible low-income people with HIV infections. The program reimburses enrolled pharmacies the allowable cost of ADAP formulary medications. Covered medications include HIV antiretroviral medications, certain medications used to treat and prevent infections associated with or co-occurring with HIV and medications to lessen the side effects of HIV antiretroviral medications.
Drug formulary: Listing of all medications that are covered by an insurer or assistance program (e.g., ADAP). Generally, if a medication is not listed on the drug formulary, the insurer or assistance program will not cover the medication costs. To access the Minnesota ADAP Formulary, refer to DHS – Program HH Medication Program (ADAP) Formulary.
E
Emergency Medical Assistance (EMA): Program for non-citizens with emergency medical conditions. Non-citizen recipients can only receive Emergency Medical Assistance. The coverage depends on the person’s immigration status and the date of arrival in the United States. Please note:
Employer-sponsored insurance (ESI): Insurance that meets the Affordable Care Act’s guidelines and is offered by an employer and/or a union.
Employer insurance information form (EIIF): Form used to request information about health insurance offered through employer and/or unions. This information is used to determine if a person qualifies for health care coverage through a Minnesota Health Care Program.
F
Federal poverty guidelines/federal poverty level (FPG/FPL): Measure of income issued every year by the U.S. Department of Health and Human Services (HHS). Federal poverty levels are used to determine a person’s eligibility for certain programs and benefits, including savings on marketplace health insurance and Medicaid and Children’s Health Insurance Program (CHIP) coverage.
I
Insurance Assistance Program: Program that pays the full or partial cost of premiums for certain types of health insurance policies for eligible low-income people living with HIV infections.
M
Medicaid/Medical Assistance (MA): Program that provides health care coverage to millions of Americans, including eligible low-income adults, children, pregnant women, older adults and people with disabilities. Medicaid is administered by states, according to federal requirements, and is funded jointly by states and the federal government.
Medical Assistance for Employed Persons with Disabilities (MA-EPD): Program that gives employed people with disabilities MA coverage when their income is more than the MA income limit. Eligible clients must be certified disabled and earn more than $65 per month.
Medicare Extra Help Program low-income subsidy: Subsidy based on a person’s federal poverty guidelines / federal poverty level. The full low-income subsidy is for people whose income is less than 135%. The partial low-income subsidy is for people whose income is greater than 135% and less than 150%. People whose income is greater than 150% do not receive a subsidy.
Medicare Savings Programs (MSP): Programs that help people who have low income pay the cost of their Medicare coverage. There are four different programs with specific rules for qualifying:
Medicare plans:
Mental health services: Provides clients with access to proper mental health care.
MinnesotaCare: Health care program for Minnesotans with low incomes. Enrollees get health care services through a health plan. Clients can choose a health plan from those serving MinnesotaCare enrollees in the county/tribal nation of residence. MinnesotaCare is funded by a state tax on Minnesota hospitals and health care providers, Basic Health Program funding, enrollee premiums and cost sharing.
MNsure: Minnesota’s health insurance marketplace.
P
Part B programs:
Q
Qualified health plans (QHP) and open market: Coverage that clients may be able to buy with or without a tax credit on MNsure. If a client qualifies for a tax credit, the tax credit can help pay the monthly premium.
R
Retirement, Survivors and Disability Insurance (RSDI): Federally funded program designed to ensure the continuation of income to people who are disabled, have reached retirement age or are the surviving dependents of those who qualified for Social Security Disability Insurance.
S
Social Security Disability Income (SSDI): Federal program that pays monthly benefits to people who acquired a disability before reaching retirement age and who are not able to work but have previously worked long enough and paid Social Security taxes.
Supplemental Security Income (SSI): Federal program that pays disability benefits to people with limited income/resources who have a disability, are blind or are age 65 or older, and who have either never worked or have not earned enough work credits to qualify for Social Security Disability Income (SSDI).
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