Emergency rule resets HIV drug access for thousands
Florida has invoked an emergency rule to sharply restrict who can receive HIV medication through the state’s AIDS Drug Assistance Program (ADAP), with changes set to bite as early as Sunday, March 1, 2026. The rule lowers income eligibility from 400% to 130% of the federal poverty level and curtails coverage of widely used antiretroviral regimens, including Biktarvy, placing continuity of treatment for thousands of residents at risk. Program data indicate roughly 30,000 Floridians are enrolled in ADAP and that Biktarvy accounts for a majority of prescriptions; advocates estimate about 16,000 people could lose medication or insurance payment support under the shift. The emergency rule lasts 90 days, while lawmakers consider budget measures that would not deliver relief until July 1, 2026.
State officials have pointed to rising costs and a projected $120 million shortfall as the rationale, arguing the program had become financially unsustainable at current eligibility levels. Legal and community challenges counter that the department has not publicly substantiated those figures and that abrupt benefit changes endanger public health by disrupting viral suppression across the state, particularly in counties that already rank among the nation’s highest for new HIV diagnoses.
What changes under the rule
The emergency rule effectively rewrites the gateway into Florida’s ADAP, which functions under federal Ryan White Part B authority as the payer of last resort for low-income people with HIV who lack adequate coverage.
| Policy lever | Before (through January 2026) | Under emergency rule (filed late February 2026) | Immediate impact |
|---|---|---|---|
| ADAP income eligibility | Up to 400% FPL (about $62,600/year for an individual) | Up to 130% FPL (about $20,345/year for an individual) | Large share of current clients become ineligible on March 1 |
| Insurance premium assistance | Available for eligible clients | Eliminated | Loss of plan-based access for many clients |
| ADAP formulary (examples) | Included single-tablet regimens widely used in Florida | Limits on Biktarvy coverage | Switches off stable regimens; risk of nonadherence |
| Duration | Standard rulemaking timeline | Emergency rule effective for 90 days | Short window for courts and Legislature to intervene |
Figures reflect ADAP thresholds and formulary actions described in the emergency rule and program communications in late February 2026. The Department of Health has told providers they must reassess clients quickly against the lower income cap, leaving clinics and case managers to re-screen thousands of people in a matter of days.
Legal maneuvers and the calendar the system must now meet
The emergency rule was filed on the eve of scheduled court proceedings over earlier attempted changes, resetting the litigation landscape and compressing the transition period for patients and providers. A separate bid for an injunction has been initiated in circuit court, challenging both the process and the state’s claim that fiscal pressure alone constitutes an “immediate danger” justifying emergency action.
| Date (2026) | Milestone | Where it sits now |
|---|---|---|
| Jan 8 | State outlines impending reductions to ADAP eligibility and coverage | Program stakeholders begin mitigation planning |
| Jan 30–31 | Expedited administrative hearing schedule granted | Ruling originally targeted for Feb 27 |
| Feb 11 | Notice of proposed rule published; public comment window opens | Formal rulemaking track runs in parallel |
| Feb 24–25 | Emergency rule filed, tightening eligibility and coverage | Supersedes prior administrative challenge timeline |
| Feb 26 | New legal filings seek to block emergency rule | Response deadlines set into March |
| Mar 1 | Cutoff date referenced in program communications | Clients risk immediate interruptions without alternative coverage |
| Mar 6 / Mar 11 | State response due; potential evidentiary hearing | Injunction bid pending |
| Jul 1 | Earliest date new state funds could start (FY 2027) | Months-long gap even if appropriations pass |
Key dates are drawn from court schedules, agency filings, and legislative calendars as reported this month, underscoring how judicial timelines now intersect with the state budget process and the 90-day lifespan of the emergency rule.
“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, a statewide advocacy lead.
“The only emergency here is the one that the Department of Health is creating through their own actions,” said Senate Democratic Leader Lori Berman, who added, “The actions of Surgeon General Ladapo and the Department of Health are shameful.” Her comments highlight a growing political split over whether budget strain justifies an emergency response that sidelines standard rulemaking safeguards.
Population-level stakes for viral suppression and prevention
Public health experts warn that the rule collides with long-standing federal and state strategies to end the HIV epidemic, which hinge on consistent access to treatment and prevention tools.
- Florida’s rule change is projected to remove medication or premium assistance for roughly half of current ADAP clients, a group already at elevated risk for treatment interruptions if costs rise suddenly.
- Sustained viral suppression prevents transmission; interruptions can trigger viral rebound and undermine community-wide prevention goals, particularly in high-burden regions of the South.
- Recent surveillance data show Florida’s rate of new HIV diagnoses remains among the nation’s highest, intensifying the consequences of any coverage shock. Advocates note that any backsliding in viral suppression rates could set back progress made under national Ending the HIV Epidemic targets.
Capacity pressures on Florida’s HIV care safety net
With the rule set to take effect before any legislative fix can arrive, Florida’s HIV care network is being asked to absorb a rapid and uneven transition.
- Case management, pharmacy access pathways, and manufacturer assistance programs are being tapped to bridge immediate gaps, but these are patchwork solutions for a statewide eligibility reset and typically were designed as stopgaps, not replacements, for ADAP.
- Shifts off single-tablet regimens can complicate adherence and clinic workflows, increasing counseling time and follow-up needs at already stretched Ryan White provider sites.
- Florida’s ADAP must still meet federal requirements, including coverage of at least one drug in each antiretroviral class; formulary changes that are technically compliant can still destabilize individuals who are suppressed on specific combinations and force clinicians to prioritize cost over regimen continuity.
Governance, compliance, and the path forward
The dispute now unfolding in Tallahassee sits at the intersection of state budget policy and federal HIV law. Florida administers ADAP under the federal Ryan White HIV/AIDS Program Part B, whose guidance, set out by the Health Resources and Services Administration in the Part B AIDS Drug Assistance Program framework, expects states to use ADAP as a payer of last resort and to protect continuity of care wherever possible.
- Emergency rulemaking in Florida must address an “immediate danger” to public health, safety, or welfare; filings now contest whether fiscal pressure meets that statutory bar and whether less onerous alternatives were considered before cutting eligibility and premium support.
- Legislative drafts in both chambers would add money or restore prior eligibility, but any fix takes effect with the new fiscal year and could still face line-item veto risk, extending uncertainty into summer even if lawmakers act.
- While state eligibility rules vary, federal Part B guidance underscores ADAP’s twin roles—drug access and, where feasible, premium support. Changes that collapse the latter shift costs to clients and clinics while raising the odds of avoidable interruptions, a tension now central to both the court challenges and budget negotiations.
Florida’s Department of Health has directed patients and providers to its online ADAP portal for current state criteria and formulary information, even as those criteria remain subject to parallel court challenges and legislative bargaining over the coming months.