- States are limiting or considering limits on programs that help people access HIV medications.
- Reductions include lowering income eligibility thresholds, restricting drug coverage, and tightening enrollment rules.
- Federal funding for HIV programs has remained largely flat for years, contributing to state budget shortfalls and is a key driver behind state-level restrictions.
Several states are cutting or considering reductions to programs that help people access HIV medications as federal funding has failed to keep pace with rising costs, according to a new report.
The February 2026 ADAP Watch report from the National Association of State and Territorial AIDS Directors (NASTAD), which tracks the fiscal health of state AIDS Drug Assistance Programs (ADAPs), warns that federal funding has “remained relatively unchanged over the last decade,” even as enrollment and healthcare costs have increased.
At least 18 states have already implemented cost-containment measures, and several others are weighing similar steps as budget shortfalls grow.
Several states have lowered income eligibility thresholds for their ADAPs or reduced the scope of covered medications, the report noted.
Florida, for example, recently reduced ADAP eligibility from 400% to 130% of the federal poverty level — a change estimated to affect more than 12,000 clients and leave many without direct access to antiretroviral medications or insurance premium assistance.
As part of its cost-containment strategy, the state has also dropped coverage of Biktarvy, a commonly prescribed single-tablet HIV regimen, and restricted coverage of Descovy to patients with specific clinical needs.
Other states have also tightened their rules. Pennsylvania lowered its eligibility from 500% to 350% of the federal poverty level, affecting roughly 1,600 clients.
Kansas has dropped its premium-assistance eligibility from 400% to 250%, while Delaware and Rhode Island have also reduced eligibility caps.
Some states have tightened recertification requirements or reduced formularies, including Arizona, Michigan, and Nevada, while several — such as Alaska and Oklahoma — have reinstated stricter six-month recertification policies.
In total, more than 20 states have adopted restrictions or are considering measures to reduce program spending.
The report points to flat federal funding for the Ryan White HIV/AIDS Program as a key factor behind states’ cost-containment measures.
Although enrollment and medication costs have increased, federal appropriations have not kept pace, leaving states to shoulder more of the financial burden.
Those pressures follow broader federal funding reductions in HIV programs in recent years, including cuts to research and prevention initiatives.
In a press release, Carl Baloney, Jr., President and CEO of AIDS United, recently noted that sustained federal investment is essential to maintaining treatment access.
“Ending the HIV epidemic in the United States requires major investment from our federal government in HIV prevention, treatment, and support services in every state, county, and city in the country,” Baloney said.
“These investments prevent transmission, keep communities safe, save money over time by avoiding more expensive care later, and save lives. Each HIV infection prevented saves an estimated half-million dollars in lifetime treatment costs. Cutting public health infrastructure now is cutting our future,” Baloney continued.
ADAPs provide access to antiretroviral therapy and insurance assistance for low- and middle-income people living with HIV.
Consistent treatment enables people to achieve viral suppression, protecting their health and preventing transmission of the virus to others.
Reductions in eligibility, formulary changes, or limits on insurance assistance could disrupt medication access for some patients.
When treatment is interrupted, HIV can begin replicating again, weakening the immune system and increasing the risk of serious illness.
Interruptions may also increase the risk of drug resistance, potentially limiting future treatment options and making it harder to maintain current rates of viral suppression nationwide.
