​The purpose of this memo is to inform ADAP enrollment workers that the ADAP Consent Form has been updated. Beginning with enrollments and re-enrollments that occur on or after October 18, 2024, previous versions of the ADAP Consent Form will no longer be accepted.

Revised ADAP Consent Form

Both the English and Spanish ADAP Consent Forms have been updated and are now valid for two years. The updated ADAP Consent Forms shall remain in effect for two years from the date of the client's signature. Please note that this was changed from one year to two years because depending on the circumstances, some clients are granted a little more than one year of eligibility.

 For currently enrolled clients who a) submitted the version of the ADAP Consent Form that is valid for one year and b) have an eligibility period that is greater than one year, ADAP staff will reach out to them before the next re-enrollment to sign the updated ADAP Consent Form that is valid for two years.

 The ADAP Consent Form is still required to be signed by clients annually during re-enrollment. This helps to ensure that the most current ADAP Consent Form is on file for each client as it may be updated at any time. Additionally, it is valid for two years to account for the fact that some clients may have an eligibility period that is a little more than a year, depending on when they enroll/re-enroll.  Additionally, as outlined below, having an ADAP Consent Form that is valid for two years will allow a client to be placed on a Temporary Access Period (TAP) at re-enrollment, until the client is able to provide all supporting documentation, including a new ADAP Consent Form. Clients will be placed on TAP if a new consent form is not provided at re-enrollment.  

 The updated ADAP Consent Forms are now available online:

• CDPH 8685 (PDF) - ADAP Consent Form
• CDPH 8685 SP (PDF) - ADAP Consent Form (Spanish)

Lastly, the updated ADAP Consent Form will be enforced October 18, 2024.

Clarification Regarding Initiating an Enrollment/Re-Enrollment Over the Phone

Clients who have an ADAP Consent Form on file that is valid for two years may initiate a re-enrollment over the phone.  However, they must be placed on a Temporary Access Period (TAP) until the client is able to provide all supporting documentation, including a new ADAP Consent Form. Enrollment workers must submit a completed TAP Form (PDF) (English | Spanish).

Scenario 1 – An existing ADAP client's eligibility period is about to expire. They are unable to re-enroll in-person with all required documentation before their eligibility period expires. They have an ADAP Consent Form on file that is valid for another year because they signed an ADAP Consent Form that was valid for two years when they last enrolled. They would like to initiate a re-enrollment over the phone.

• Step 1: Client calls to initiate a re-enrollment over the phone.
• Step 2: Enrollment worker initiates a secure email or fax to obtain all supporting documentation for ADAP eligibility, including a new ADAP Consent Form. If the client is unable to provide all supporting documentation during the phone enrollment, the enrollment worker will also provide a TAP Form to the client. If the client is unable to complete the TAP Form and send back via email or fax, the enrollment worker will complete the enrollment worker section of the TAP Form attesting that they screened the client over the phone and are placing the client on a TAP. The enrollment worker will place the client on a TAP.
• Step 3: Enrollment worker will initiate a second secure email to obtain the remaining supporting documentation, if needed.

Please note, enrollment workers should only place clients on a TAP over the phone if the client has been screened for eligibility and intends to re-enroll.

Scenario 2 - An existing ADAP client's eligibility period is about to expire. They are unable to re-enroll in-person with all required documentation before their eligibility period expires. They have an ADAP Consent Form on file that is also about to expire because they signed an ADAP Consent Form that was valid for one year when they last enrolled. They would like to initiate a re-enrollment over the phone. They must provide a new ADAP Consent Form to initiate a re-enrollment over the phone.  

• Step 1: Client calls to enroll over the phone.
• Step 2: Enrollment worker initiates a secure email or fax to obtain a new ADAP Consent Form and will send a TAP form to the client.
• Step 3: Once the completed ADAP Consent Form is received, the enrollment worker will call the client back and to finalize the process for placing the client on a TAP. If the client is not able to provide a new ADAP Consent Form, they cannot be placed on a TAP for a re-enrollment because the ADAP Consent Form they last sign is only valid for one year from their last enrollment. If the client is unable to complete the TAP Form and send back via email or fax, the enrollment worker will complete the enrollment worker section of the TAP Form attesting that they screened the client over the phone and placing the client on a TAP.
• Step 4: Enrollment worker will initiate a second secure email to obtain the remaining supporting documentation, if needed.

Please note, the Blank Supporting Document is not acceptable for new enrollments or re-enrollments.

If you have any questions regarding the information provided in this memo, please contact your OA Advisor.

Thank you,

 ​​

Joseph Lagrama

ADAP Branch Chief

California Department of Public Health