This month, thousands of Floridians living with HIV woke up to find out their medication coverage had been cut — overnight. The Florida Department of Health slashed AIDS Drug Assistance Program (ADAP) eligibility from 400% of the federal poverty level (FPL) to just 130%, effectively eliminating coverage for more than 16,000 people who depend on ADAP for life-saving antiretroviral therapy.
For context: 130% of the FPL is roughly $20,345 a year. A single person earning $25,000, barely above the poverty line, would have lost access to medications that can cost thousands of dollars per month without assistance.
The Legislature Stepped In — But Only Just
In an almost unanimous show of bipartisan support, the Florida Legislature passed HB 697, directing nearly $31 million back to ADAP and requiring the Department of Health to maintain eligibility at 400% FPL. Both chambers voted unanimously. The fix is now headed to Governor DeSantis’s desk, reportedly with his support.
But there’s a catch: the funding is only guaranteed through June 30, 2026. After that, the fight begins again in the next budget cycle. And the Department of Health must submit monthly accounting reports to the Legislature going forward — a measure that signals just how little confidence lawmakers have in how the program has been managed.
The funding is only guaranteed through June 30. After that, the fight begins again.
This Isn’t Just a Florida Problem
Florida’s ADAP crisis is dramatic, but it’s part of a broader national pattern. According to a March analysis by KFF and the National Alliance of State and Territorial AIDS Directors, at least 18 states have pulled back their ADAP programs in some form over the past year. Congress has kept federal ADAP funding flat at $900.3 million annually since 2014 — but new enrollments jumped 30% from 2022 to 2024, largely because states ended pandemic-era Medicaid expansions and pushed patients back to ADAP.
The math doesn’t work. More patients, flat funding, and state governments looking for cuts. This is a pressure point that isn’t going away.
What This Means for Covered Entities and Ryan White Providers
If your organization serves patients who rely on ADAP or Ryan White programs, you’re likely already feeling the downstream effects: patients missing doses, delaying care, or showing up in crisis. And the uncertainty isn’t over. The next state budget cycle, the next federal appropriations fight, could bring another round of cuts.
This is exactly the kind of instability that a well-structured Premium Insurance Assistance Program (PIAP) is designed to address. By helping eligible patients enroll in ACA Marketplace plans — and covering their monthly premiums using 340B savings or other funding streams — a PIAP creates a private insurance safety net that doesn’t depend on state politics.
When a patient is enrolled in a marketplace plan through PIAP, they have access to comprehensive coverage including primary care, specialty visits, and full prescription drug benefits. They’re not one budget fight away from losing their medication.
PIAP + 340B = a care model built to last. American Exchange helps covered entities and Ryan White providers design and manage PIAP programs that keep patients covered — no matter what happens in Tallahassee or Washington. Meet with our team to learn more here.
Sources
Florida Legislature Approves Bill Restoring Funds to AIDS Drug Program — WUSF
$31M Infusion for AIDS Drug Program Passes the Legislature — Florida Phoenix
Florida Restores ADAP Access, but the Fight to Cover a Popular HIV Med Continues — POZ
A Conversation with Amber R. Tynan, CEO of Big Bend Cares — Managed Healthcare Executive
AHF: President Trump, Save Florida’s AIDS Drug Assistance Program — AIDS Healthcare Foundation
