A 6-week clock is now ticking for many Floridians living with HIV.

The Florida Department of Health says it is overhauling the AIDS Drug Assistance Program (ADAP) to avoid a projected budget shortfall, shifting to direct medication coverage only for clients at or below 130% of the federal poverty level. Separate emails circulated among advocates and providers describe impending coverage disruption and medication restrictions beginning March 1, 2026. 

In a Jan. 8 notice, the Department of Health attributed the changes to “rising health care insurance premiums nationwide and lack of additional Ryan White Grant funding.” The department says it will “cover costs during a two-month transition period” for impacted clients and framed the shift as necessary to prevent “a shortfall of more than $120 million for Florida.” 

ADAP is one of the state’s most important safety nets for people living with HIV who are uninsured or underinsured. Florida’s DOH describes the program as providing HIV medications either directly or through purchase of health insurance that includes HIV medication coverage. For many clients, maintaining access to consistent antiretrovirals is the difference between staying virally suppressed and risking serious health complications. 

While the state frames this as necessary because of a projected shortfall one community advocate has a different theory. 

“Advocates are convinced that the attack on ADAP is fueled by the DeSantis Administration’s bigoted attacks on gender ideology given that many LGBTQ individuals rely on this lifeline for access to life-saving medications,” said Michael Emanuel Rajner, former consumer representative to the Florida Department of Health’s ADAP Advisory Workgroup. "Advocates fear there is financial mismanagement with the AIDS Drug Assistance Program given the sheer lack of financial transparency the community once was provided by DOH.”

According to a fact sheet that’s being circulated these changes violate federal law. 

“The Florida Department of Health cannot reduce ADAP eligibility, shrink the formulary, or eliminate insurance premium payments because doing so would violate federal law, undermine public health, increase HIV transmission, worsen health disparities, impose higher long-term costs, and jeopardize the health and stability of thousands of Floridians living with HIV,” reads the sheet that was put together by a group of advocates. “Maintaining and strengthening ADAP is essential for Florida's HIV response, public health system, and moral obligation to protect vulnerable residents.” 

Michael Ruppal, executive director of the AIDS Institute, said the state’s plan is moving forward with limited public detail about how the clients and clinics are expected to navigate the transition.

“All indications were they were backing off this plan until the very last minute today, and DOH pulled the trigger. They did this knowing the facts and all the people that would be impacted,” Ruppal said in an email shared with OutSFL. “Preliminary estimates (to be verified) we are looking at around 8,500 losing coverage 3/1 and more than 15,000 losing services or being impacted. As you can see, there are no details in this misinformed plan. We are still hopeful for a reversal if legislators and advocates work together.” 

Ruppal emphasized the figures are “to be verified,” but his estimates reflect what many providers and advocates say they are now bracing for: a sudden surge of patients scrambling to secure coverage, medication access, and clinical continuity under tighter eligibility rules.

OutSFL also reviewed a Jan. 8 email “ADAP Formulary Changes” sent from a Florida Department of Health email address by Dr. Ulyee Chloe, who is identified in the signature as a director with the FDoH in Pinellas County and a statewide medical director for county health systems. 

The email states that ADAP is moving to a “financially sustainable model” and says the current approach, described as “direct dispense, CVS Caremark and insurance,” will continue for a two-month transition period before the program moves to direct medication dispensing and caps eligibility at 130% of the federal poverty level. 

The message also lays out medication restrictions. It states that Biktarvy will be removed, and Descovy will be restricted to patients with renal insufficiency. The email adds that other antiretroviral medications, including Tivicay, will remain available, while noting that costs will be monitored and adjusted if needed.

The email instructs providers to transition some patients to alternative regiments at follow-up visits and to ensure patients currently taking Biktarvy or Descovy have enough medication to reach their next clinical visit prior to March 1. 

Providers and advocates stress that people with HIV should not stop taking medication, and should contact their clinic or case manager as soon as possible to verify eligibility and plan for continuity of care during the transition period.

The FDOH notice encourages clients to connect with community resources and patient assistance programs and lists several resource options.

For clients who may be impacted, the next few weeks are likely to be the difference between a smooth transition and a dangerous gap in care.