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States move to limit access to HIV treatment

This electron microscope image made available by the U.S. National Institutes of Health shows a human T cell, in blue, under attack by HIV, in yellow, the virus that causes AIDS. The virus specifically targets T cells, which play a critical role in the body's immune response against invaders like bacteria and viruses. Colors were added by the source. (Seth Pincus, Elizabeth Fischer and Austin Athman/National Institute of Allergy and Infectious Diseases)
Apoorva Mandavilli New York Times

Tens of thousands of Americans are losing access to treatment for HIV as nearly 20 states impose restrictions on assistance programs and several others weigh such changes.

The states, led by both Democrats and Republicans, are tightening requirements for people benefiting from Ryan White AIDS Drug Assistance Programs, or ADAPs, according to an analysis released Monday by health research group KFF.

The programs help pay for HIV medications or provide them free to some people, and pay insurance premiums for others.

HIV medications suppress the virus to undetectable levels, eliminating the chance of spreading it to others. Interrupting treatment may lead to an increase in new infections and in AIDS cases.

Moreover, some people may try to extend their supplies by alternating days or sharing their pills with others. If the virus replicates in people with only partial protection, it can become resistant to the medications. People living with the virus may then pass the resistant virus on to others.

The biggest change took effect in Florida on Sunday, when officials cut off benefits for at least 16,000 residents living with HIV. The state also will no longer cover Biktarvy, the most widely prescribed HIV medication.

On Friday, the Centers for Medicare & Medicaid Services opened a special enrollment period allowing Floridians who lose financial support for insurance premiums to choose a new plan. The period ends April 30.

ADAPs support roughly 25% of the 1.2 million people living with HIV in the United States. The programs had a 30% surge in enrollment from 2022 to 2024, in part because states were removing people from Medicaid after keeping them on during the pandemic.

ADAPs are funded by Congress through the Ryan White federal HIV program. The programs are contending with rising costs as HIV drugs become more expensive even as health care subsidies have expired, sending premiums soaring.

At the same time, funding for the programs has remained flat for more than a decade.

The financial constraints have led 18 states to take at least one cost-cutting measure, including restricting eligibility by income and reducing the number of medications covered. Five other states are considering changes that would go into effect next month.

More states may consider such measures as new work requirements drive patients out of Medicaid and increase enrollment in ADAPs, some experts warned.

This article originally appeared in The New York Times.