Florida moves to cull thousands from HIV drug access program

ORLANDO, Fla. - The Florida Department of Health has issued emergency rules that could sharply restrict access to HIV medications for thousands of residents. 

The move has sparked legal and political backlash as state officials and advocates clash over funding and eligibility requirements.

What we know:

The department announced Wednesday that, beginning Sunday, it will reduce eligibility for the state’s AIDS Drug Assistance Program, known as ADAP. Subsidies will now be limited to people earning at or below 130% of the federal poverty level, down from the previous threshold of 400%.

Under current federal guidelines, 400% of the poverty level equals about $62,600 a year, while 130% equals roughly $20,345. HIV advocates estimate that about 16,000 of the 30,000 Floridians enrolled in ADAP could lose access to assistance.

The emergency rules also restrict insurance coverage for Biktarvy, a once-daily HIV medication used by roughly 60% of those enrolled in the program.

The rules will remain in effect for 90 days and may be renewed.

What we don't know:

It remains unclear how quickly affected patients will lose coverage or what alternative options, if any, will be made available to those who no longer qualify. State officials have cited a $120 million federal funding shortfall, but advocates dispute that explanation and question whether the gap is as large or immediate as described.

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Lawmakers in the Florida House of Representatives and the Florida Senate have earmarked funds in their proposed budgets to address the gap. However, it is uncertain when or how quickly that money could be deployed, and whether it would prevent coverage disruptions in the interim.

The backstory:

The emergency rule was filed a day before a scheduled hearing in a lawsuit brought by the AIDS Healthcare Foundation. The group sued the health department in January, alleging the agency unlawfully changed ADAP eligibility rules without following required procedures.

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In January, Florida Surgeon General Joseph Ladapo said reductions in coverage stemmed from a $120 million shortfall in federal funding for the program. 

What they're saying:

Advocates argue that the state had other options to prevent abrupt cuts and accuse officials of bypassing normal rulemaking requirements.

"The Department spent two months cutting people off without following the law. When we took them to court, they filed an emergency rule at midnight to dodge accountability," said Esteban Wood, director of advocacy and legislative affairs for the AIDS Healthcare Foundation.

"The only emergency here is the one that the Department of Health is creating through their own actions," said Lori Berman, the Florida Senate’s Democratic leader. "The actions of Surgeon General Ladapo and the Department of Health are shameful."

State health officials have maintained that funding constraints necessitated the changes, though they have not publicly detailed how the emergency rule will affect individual patients in the coming weeks.

Big picture view:

Florida has one of the highest rates of new HIV diagnoses in the nation, and ADAP serves as a safety net for low- and moderate-income residents who rely on consistent medication to maintain viral suppression. Advocates warn that interruptions in treatment could lead to worsening health outcomes and increased transmission risk.

The clash highlights broader tensions over public health funding and rulemaking authority in the state, as courts, lawmakers and health officials weigh competing claims of fiscal necessity and legal compliance.