Will HIV cases spread as state cuts jeopardize access to drugs?
Will HIV cases spread as state cuts jeopardize access to drugs?
Ken Alltucker, USA TODAYSat, March 7, 2026 at 10:04 AM UTC
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Will HIV cases spread as state cuts jeopardize access to drugs?
A cornerstone of the effort to combat the nation's HIV epidemic is beginning to show fiscal cracks.
The Ryan White AIDS Drug Assistance Program has helped more than a quarter million Americans living with HIV to get life-saving medications, health insurance or both. But funding pressure has prompted 18 states to cut costs, jeopardizing care for thousands of Americans living with HIV, according to an analysis by the health policy nonprofit KFF.
Another 5 states are considering changes to stretch out limited funding for Ryan White assistance programs, known as ADAPs, KFF said.
While these states have enacted or are considering changes, some experts worry more states could follow. Not only do program cuts harm a portion of the 1.2 million Americans living with HIV, people could get sicker without the viral-suppressing medications and transmit the virus to others.
"We're worried about all states," said Tim Horn, director of medication access for the National Alliance of State and Territorial AIDS Directors. "Sometimes it seems budget deficits appear out of thin air."
What is the Ryan White ADAP program?
The federally-funded Ryan White HIV/AIDS program provides money to state-based ADAPs to pay for medications and insurance for people with HIV. ADAPs also received state funding and other sources of revenue such as drug rebates.
The National Alliance of State and Territorial AIDS Directors and KFF said several factors are pressuring state-based ADAP programs.
HIV medication and health insurance costs have soared, straining state programs. These programs also have experienced a surge of people seeking assistance. Meanwhile, Congressional funding for Ryan White programs has been flat in recent years.
In 2024, these state programs served more than 257,000 people, a jump of 30% from 2022, according to figures from the National Alliance of State and Territorial AIDS Directors.
The programs mainly serve lower-income populations. Nearly 1 in 4 people with HIV get services from ADAP programs.
Horn said the enrollment surge came when the federal government resumed Medicaid eligibility checks that were suspended during the COVID-19 pandemic. HIV patients who no longer qualified for Medicaid turned to state ADAPs to pay for their medication, insurance or both.
Other federal health policy changes further squeezed ADAPs. Congress didn't extend the Affordable Care Act's enhanced subsidies that lowered consumers spending on insurance plans. ACA plans became more expensive this year and consumers' average insurance costs spiked 114% because of the expiration of the enhanced tax credits, according to a KFF analysis.
More pressure is on the horizon. President Donald Trump's tax cut and spending legislation is projected to trim more than $900 billion in federal spending on Medicaid over the next decade. The law's changes could leave millions of Americans uninsured over that time period, according to estimates from the nonpartisan Congressional Budget Office.
These states are tightening eligibility
Florida enacted changes that are expected to cut off assistance for an estimated 10,000 to 16,000 residents. Florida sharply reduced income limits for the program.
Florida previously extended eligibility to people who earned up to 400% of the federal poverty level, or $63,840 per year. Now, Florida cuts off residents who earn more than 130% of the federal poverty level, or $20,748 per year.
Florida's program also will no longer cover Biktarvy, the most widely prescribed HIV drug. A one month supply of the drug for those without insurance costs an average $5,132, according to GoodRx.
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The Florida Department of Health said the program changes were needed to prevent a budget gap of more than $120 million.
Florida's changes "are probably the most severe, but other states are cutting back on income eligibility," said Jennifer Kates, senior vice president and director of the Global and Public Health Policy Program at KFF.
ADAP programs in Pennsylvania, Kansas, Delaware and Rhode Island have changed income eligibility limits, according to the National Alliance of State and Territorial AIDS Directors. Changes enacted by other states include reducing funding for medical services, implementing twice-a-year eligibility checks and adopting annual or monthly spending caps per enrollee.
No states have imposed waiting lists − a common tactic used in the early 2000s when too many people sought help from ADAPs with too little funding. The administrations of Presidents George W. Bush and Barack Obama had to approve emergency funding to reduce waiting lists, Kates said.
THOUGH No state program has put people on a waiting list for the past decade, KFF said, (DELETE though) states occasionally used other cost-cutting strategies.
Florida's changes are "a new level of restriction we haven't seen in some time," Kates said.
Why advocates worry about HIV service cuts
Experts say cuts to HIV medications and other assistance could put more Americans at risk for the disease.
While cases are far below the levels reached in the 1990s, more that 39,000 U.S. residents have been diagnosed with HIV as of 2023, according to figures from the Centers for Disease Control and Prevention. Nearly 4,500 deaths in 2023 were attributed to HIV, the virus that weakens the immune system and causes AIDS, the CDC said.
People with HIV who are taking antiretroviral medications typically maintain their health, and pushing viral loads to undetectable levels also protects sexual partners from infection, Kates said.
But that can change when they no longer get HIV medication.
"If viral load goes up because they don't have their meds, or they have inconsistent access, they could be transmitting HIV to a partner," Kates said.
Researchers from the University of California, San Diego estimated the potential impact of Florida's ADAP cuts on people living in Miami-Dade County, where about 1 in 3 new HIV cases are diagnosed in Florida.
UCSD researchers estimated of the 7,400 Miami-Dade residents who currently get ADAP services, 3,700 people are no longer eligible under Florida's tightened restrictions.
That lack of coverage could lead to 1,000 new cases of HIV in Miami-Dade County over the next five years, said Natasha Martin, a UCSD professor and vice chief of global public health.
The lifetime cost of treating someone with HIV is slightly more than $1 million, so researchers project the ADAP eligibility cuts could cost another $1 billion for treating an additional 1,000 Miami-Dade County residents with HIV.
"It just does not make economic sense," Martin said. "We are going to be paying billions of dollars to care for newly infected people with HIV as a result of these changes."
This article originally appeared on USA TODAY: States cut HIV drug programs amid budget shortfall
Source: “AOL Money”
