HIV Medical Management Services

The Hawai‘i Department of Health provides HIV medical management services to help people living with HIV and their doctors monitor and maintain their health. Services are provided through three programs: HSPAMM, HDAP, & H-COBRA.

Hawai‘i Seropositivity & Medical Management Program (HSPAMM) & Link-to-Care
HSPAMM’s “Link-to-Care” services are for individuals who are HIV positive, live in Hawai‘i, and might be at risk for foregoing or postponing routine medical visits and/or lab work (e.g., for reasons such as cost). The aim of Link-to-Care services is to support HIV positive individuals in accessing and remaining in medical care. Link-to-Care provides access to a routine panel of HIV-related laboratory tests (including T-cell counts and viral load tests) that are essential in monitoring the health of individuals living with HIV. The routine panel can be repeated every six months, or more frequently if needed. In addition to the routine panel of tests, Link-to-Care also provides access to lab tests, such as for HIV drug resistance, which may periodically be necessary for effective management of HIV. If a patient lacks insurance coverage to pay for the medical provider’s office visit in conjunction with lab testing, payment through HSPAMM may be arranged. Link-to-Care services are provided at no cost to the patient.

Who is eligible for HSPAMM/Link-to-Care? Anyone who is HIV positive, living in Hawai‘i, and faces barriers accessing routine doctor visits and laboratory testing is eligible.

How does someone start getting HSPAMM/Link-to-Care services? All Hawai‘i residents living with HIV who might otherwise skip routine visits or laboratory tests, are strongly encourage to take advantage of these free services to monitor and help manage their health. Patients need to be enrolled by their medical provider. Medical providers can call HSPAMM at (808) 733-9360 (Honolulu number) to get new patient enrollment packets.

HIV Drug Assistance Program (HDAP)
HDAP provides medication to Hawai‘i residents living with HIV, who have limited income and who cannot get HIV medications from any other sources, or need assistance with insurance-related costs (such as co-pays and deductibles) for HIV medications. There is no cost to the patient to participate in HDAP. HDAP provides FDA-approved medications used to:

  • Treat HIV infection
  • Prevent and treat opportunistic infections
  • Treat HIV-associated anemia and wasting
  • Treat or improve side effects of HIV
  • Treat co-occurring conditions
  • The drugs that can be provided by HDAP are listed on the HDAP Formulary.

Who is eligible for HDAP? To be eligible for HDAP, an individual must:

  • Live in Hawai‘i
  • Be HIV positive
  • Be ineligible for Medicaid
  • Lack prescription drug insurance, or need assistance with the cost of accessing medications under insurance
  • Have family income not more than 400% of the Federal Poverty Level for Hawai‘i (2024: $69,240 per year for a single person; $94,000 per year for a family of two)
  • Be enrolled in the case management program of one of the agencies funded by the state to provide HIV Case Management

How does someone apply for HDAP? Applications for HDAP are handled through agencies that partner with the Department of Health to provide HIV Case Management. The case management agency is required to maintain documentation to support eligibility, including documentation of residence, family income, and insurance. Clients receiving HDAP services must be recertified through the case management agency every six months to maintain eligibility in HDAP.

Hawai‘i Insurance Continuation Program (H-COBRA)
In some situations, H-COBRA can pay health insurance premiums on behalf of an eligible individual. Hawaii residents living with HIV who need assistance affording their health insurance premiums should work with their HIV case manager to determine whether H-COBRA assistance is an option.
Examples of some requirements for H-COBRA to be able to pay health insurance premiums:

  • The insurer must accept third-party payment.
  • H-COBRA must make payment directly to the insurer or insurance administrator. H-COBRA is prohibited from making payment of any kind to an individual (client, participant, insured person, etc.) and therefore cannot reimburse for payments made by an individual.
  • The client must be able to provide adequate documentation of the required payment (such as a bill from the insurer).
  • The insurance must include adequate coverage for prescription medications.
  • H-COBRA is a “payer of last resort” and cannot pay for services that can reasonably be expected to be covered by another payer.

Who is eligible for H-COBRA? To be eligible for H-COBRA, an individual must:

  • Live in Hawai‘i
  • Be HIV positive
  • Be ineligible for Medicaid
  • Lack prescription drug insurance, or need assistance with the cost of accessing medications under insurance
  • Be eligible to purchase insurance that meets H-COBRA guidelines and for which payment arrangements can be established
  • Have family income not more than 400% of the Federal Poverty Level for Hawai‘i (2024: $69,240 per year for a single person; $94,000 per year for a family of two)
  • Be enrolled in the case management program of one of the agencies funded by the state to provide HIV Case Management

How does someone apply for H-COBRA? Contact the HIV Case Management agency on your island for assistance applying for H-COBRA. The case management agency is required to maintain documentation to support eligibility, including documentation of residence, family income, and insurance. Clients receiving H-COBRA services must be recertified through the case management agency every six months to maintain eligibility in H-COBRA.

Confidentiality Policy
HSPAMM/Link-to-Care, HDAP and H-COBRA records are always kept confidential. Participant’s identifying information is needed to determine eligibility, and to provide and pay for the programs’ services and to coordinate care. These records are protected by from release by:

  • Hawai‘i Administrative Rules title 11, chapter 156
  • Hawai‘i Revised Statutes (H.R.S.) §325-101 Confidentiality of Records and Information
  • Hawai‘i Revised Statutes (H.R.S.) §325-16 Informed Consent for Testing or Disclosure

The staff of HSPAMM, HDAP and H-COBRA will not disclose protected information without an individual’s written consent. State law prohibits unauthorized disclosure of protected information by staff even after termination of their employment.