The Ryan White Part B Program provides help for low-income people living with HIV/AIDS in Maine. When you work with us, your personal information is completely confidential.
How do I get help from the Ryan White Part B Program?
To become a program client, fill out the documents below, or have your Case Manager help you with them. Then, email your completed documents to RyanWhitePartB@maine.gov, fax them to (207) 287-3498, or mail them to: ADAP, 40 State House Station, Augusta, ME 04330-9758. If you need help, please call us at (207) 287-3747.
- Form A: Ryan White Part B Application (PDF - English)
- Application attachment: Form C: DHHS Release - ADAP (PDF - English)
- Application attachment for clients with no income: Form D: Statement of No Income (PDF - English)
- Form E: Application attachment for clients who need their documents translated into French, Portuguese, or Kinyarwanda.
ADAP (AIDS Drug Assistance Program)
ADAP is for people with HIV/AIDS who live in Maine and make less than 500% of the federal poverty level. ADAP helps people get the prescription drugs that treat HIV, HIV-related conditions, and prevent infections.
What kind of help is available?
ADAP can pay for your medical insurance, medication co-pays, and some blood work. These medications are covered by ADAP: ADAP Quarterly Formulary Report (PDF).
How do I get help?
You can get help by filling out the appropriate form(s) from the list below.
- Form F: MaineCare Premium Assistance Application (PDF - English)
- Form G: Private Individual Insurance Premium Assistance Application (PDF - English)
- Form H: Private Employer Premium Assistance Application (PDF - English)
- Form I: Lab Assistance Application (PDF - English)
- Form J: Copay Reimbursement Application (PDF - English)
- Form K: DHHS Release - Financial Assistance (PDF - English)
- Form S: Medicare Part D Premium-Assistance Application (PDF - English)
- Form L - DHHS Release Emergency Contact Assistance (PDF - English)
Dental Help
Dental help is for low-income people with HIV/AIDS who live in Maine and have no other way to pay for dental care.
What kind of help is available?
The Ryan White Part B Program can help pay for dental insurance and some dental work, including things like dentures, cleanings, exams, x-rays, and fillings.
How do I get help?
You can get help by filling out the appropriate forms from the list below.
- Form M: Dental Insurance Application (PDF - English)
- Form N: Dental Assistance Application (PDF - English)
- Form K: DHHS Release - Financial Assistance (PDF - English)
Housing Help
Housing help is available for low-income people with HIV/AIDS who live in Maine and have no other way to pay for rent or utilities. This includes housing assistance for children who are living with HIV whose name is not on the bill or lease.
What kind of help is available?
The Ryan White Part B Program can help pay rent, heat, or electricity. The Ryan White Part B Program cannot pay for security deposits or your mortgage.
How do I get help?
You can get help by filling out the forms below.
- Form O: Housing Assistance Application (PDF - English)
- Form K: DHHS Release - Financial Assistance (PDF - English)
- If you are applying for rental assistance, we also need this form: IRS form W-9 for landlords (PDF)
Food Help
Food cards are available for low-income people with HIV/AIDS who live in Maine and have no other way to pay for food.
What kind of help is available?
You can apply for monthly grocery store gift cards. Cards cannot be used for alcohol or tobacco products. Get information on healthy eating at ChooseMyPlate.gov.
How do I get help?
You can get help by filling out the forms below.