Thousands of low-income people living with HIV could be losing drug coverage as states impose limitations on HIV assistance programs amid constrained budgets — raising alarms over consistent access to lifesaving medications.

Many factors are putting budget constraints on state programs, including federal funding — which has remained flat for years and hasn’t been adjusted for inflation — increased drug costs and rising insurance premiums.

The Ryan White HIV/AIDS Program is the national safety-net program supporting more than 600,000 low-income people living with HIV across the nation. States receive federal grants and drug rebate money — the latter making up the bulk of state program budgets — to, among other things, help pay for medications and support community groups and specific populations, such as women and children.

Congress has kept key drug assistance funding at $900.3 million annually since 2014. New enrollments for state programs jumped 30% from 2022 to 2024, in part because states cut off pandemic-era Medicaid assistance.

As of January, at least 18 states have pulled back their Ryan White AIDS Drug Assistance Programs, known as ADAPs, in some way, according to a March 2 analysis by health research group KFF and a report by the National Alliance of State and Territorial AIDS Directors, which offers consultation for states.

There are roughly 1.2 million people in the United States living with HIV, and about 1 in 4 people get support from a state drug assistance program.

A disproportionate number of HIV/AIDS patients are gay, bisexual and other men who have male-to-male sexual contact, according to the federal Centers for Disease Control and Prevention. LGBTQ+ communities have been targeted in recent years by some federal and state policies, including the rollback of civil rights, shutting down a youth mental health hotline, restricting health care access, and imposing discussion and book bans in public schools.

Florida has introduced the most dramatic restrictions on income eligibility for its HIV drug program — cutting individual eligibility for the program from 400% of the federal poverty level to 130%. That means uninsured and underinsured people up to that 400% poverty line no longer have coverage under the program.

Read the full article about HIV drug assistance programs by Nada Hassanein at Stateline.