Thousands to lose AIDS drugs under Florida cuts

Lawrence Mower and Romy Ellenbogen, Tampa Bay Times on Jan 14, 2026

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TALLAHASSEE, Fla. — At least 10,000 Floridians could lose access to life-saving HIV medication because Congress didn’t extend the Affordable Care Act tax credits last fall, according to Gov. Ron DeSantis’ administration.

The Florida Department of Health is justifying deep cuts to the AIDS Drug Assistance Program, which provides medication to low-income people living with HIV/AIDS, by saying it will prevent a dramatic $120 million funding shortfall.

The department is mailing letters this month to thousands of recipients, telling them they’ll be cut off from the decades-old program on March 1.

Under the new version of the program, only the poorest Floridians will have access.

Florida Surgeon General Joseph Ladapo warned lawmakers Wednesday that the situation could become a “crisis” without intervention.

“It is a serious issue,” Ladapo said. “It’s a really, really serious issue.”

His Department of Health has not asked the Legislature to fill in the funding, though Ladapo on Wednesday suggested there may be funding solutions that aren’t onerous. And in Senate committees Wednesday, the department was accused of dropping a bombshell on thousands of Floridians with little notice.

“I can’t understand why there’s been no transparency,” said David Poole, who oversaw Florida’s AIDS program from 1993 to 2005. “There is something seriously wrong.”

The program’s cuts could be especially impactful in Florida, which has long been at the top of the list for states with high HIV rates. In 2016 and 2021, Florida had the highest number of new HIV cases of any state.

The Department of Health has been looking at ways to restructure the program since the federal government shutdown last fall, Ladapo said.

Committee chair Sen. Jay Trumbull, R-Panama City, said the issue is likely to be negotiated in budget talks this session.

“It’s a big deal,” he said.

Congress shut down in October as Republicans and Democrats fought over the impending expiration of the Affordable Care Act’s enhanced premium tax credits. Federal lawmakers couldn’t find a resolution, and the tax credits expired at the end of the year.

Florida, more than any other state, is likely to have residents see high health insurance premium spikes, in part because of the state’s long refusal to expand Medicaid.

Nearly 4.5 million people in Florida receive health insurance through the federal marketplace and had their bills subsidized by the enhanced tax credits.

Among the states, Florida also has one of the largest shares of people who use the AIDS Drug Assistance Program who are on the federal marketplace: about 31% as of 2023.

That includes Michael Rajner, who once served on the Florida program’s state advisory work group. He told senators that the cash price for his drugs is $7,500 a month.

“This program is a lifeline. It has changed the HIV epidemic,” he told lawmakers.

Florida’s way of culling the program reduces the income eligibility. Previously, the program was open to those making up to 400% of the federal poverty level, or $62,600 for an individual. Soon, only those making up to 130% the federal poverty level, or $20,345 for an individual, will be eligible.

Other states have faced far more modest cuts, according to national experts who questioned the state’s methodology. Pennsylvania, for example, cut its eligibility last fall from 500% to 350% of the federal poverty level.

The department did not respond to questions from the Times/Herald about the program’s funding.

How many Floridians are losing coverage isn’t precisely known. Ladapo’s rough estimate was 10,000 people, or nearly a third of recipients. The National Alliance of State and Territorial AIDS Directors estimates the figure will be higher: more than 16,000.

The state’s changes to the drug program will also eliminate access to Biktarvy — the most popular medication for people with HIV/AIDS — according to an email sent from the Florida Department of Health in Pinellas County and obtained by the Times/Herald.

Carl Schmid, the executive director of the HIV+Hepatitis Policy Institute, called the state’s abrupt changes to the drug coverage program cruel and life-threatening.

“This is a long-established program that’s been around for decades and that people are relying on to live,” Schmid said.

Ladapo said his team had been “tirelessly trying to figure out a solution,” including by having conversations with the U.S. Department of Health and Human Services, other states and some HIV drug manufacturers.

Ladapo, in front of senators on a health care appropriations subcommittee, explained the state’s AIDS drug program as being funded from different pools.

He said a small amount comes from federal grants, a larger amount comes from the federal Ryan White HIV/AIDS program, and an even larger amount comes from rebates from drug manufacturers, which he said have some “inherent instability.”

“That part is probably the most sort of unstable because there’s some discretion involved with it,” Ladapo said.

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