Potential Budget Decisions in Florida Could Significantly Affect HIV Care: Lindsey Dawson, MA

Lindsey Dawson, MA, associate director of HIV policy at KFF, spoke with The American Journal of Managed Care^® about an analysis she recently cowrote,¹ “Constrained Budgets Lead States to Restrict HIV Drug Access Through Ryan White,” where she and coauthor Jennifer Kates, PhD, detailed how budget cuts have led to some states restricting access to HIV drugs through the Ryan White HIV/AIDS Program.

The funding for HIV assistance in states primarily comes through AIDS Drug Assistance Programs (ADAPs), which provides HIV treatment and insurance assistance for those living with HIV across the country. Florida indicated that, due to budget constraints, it would be limiting eligibility for its ADAP, reducing the federal poverty level cutoff from 400% to 130%, the equivalent of decreasing the maximum income of patients from $63,840 to $20,748 a year. The state government also indicated that it would be taking the single-tablet regimen of bictegravir/emtricitabine/tenofovir alafenamide (Biktarvy; Gilead) off of the formulary list, which could affect access to the antiretroviral therapy. Dawson stated that such changes could leave thousands without coverage

Although the Florida state senate has since passed a law that would walk back some of these decisions,² the question of how states will address these budgeting shortfalls still persists. Even with some states needing to consider these cuts, about half of all states have no plan to reconsider the budget given to their ADAP, including New York and California. Dawson reiterated that each state will likely approach the budget differently. This could include reducing formularies or making recertification more challenging as potential options to reduce the budget needed for the ADAP.

Dawson discusses the “menu” of options that states have to choose from to reduce spending by the ADAPs, including weighing whether reintroducing waiting lists for coverage or reducing eligibility wholesale are the better options.

References

1. Dawson L, Kates J. Constrained budgets lead states to restrict HIV drug access through Ryan White. KFF. March 2, 2026. Accessed March 11, 2026. https://www.kff.org/hiv-aids/constrained-budgets-lead-states-to-restrict-hiv-drug-access-through-ryan-white/

2. Goñi-Lessan A. Florida senate passes a fix for cuts to AIDS drug program. WUSF. March 11, 2026. Accessed March 11, 2026. https://www.wusf.org/politics-issues/2026-03-11/florida-senate-passes-fix-cuts-aids-drug-program