Florida ADAP funding bill awaits governor’s signature as key gaps remain

A funding bill that would partially restore cuts made to Florida’s AIDS Drug Assistance Program (ADAP) is awaiting the signature of Governor Ron DeSantis. Following sustained outcry and demonstrations by HIV advocates, the state legislature passed a measure that would reinstate eligibility for more than 11,000 people who lost access to the program earlier this year. However, gaps in coverage—particularly premium assistance—remain unresolved. The commonly prescribed HIV medication Biktarvy remains off the ADAP formulary, and Descovy is subject to restricted use.

HB 697 temporarily reverses recent cuts and restores ADAP eligibility through June 30, the end of the current fiscal year. The bill is intended as a stopgap while the state finalizes its next budget. Separately, the Florida Senate has proposed $118 million for ADAP in the 2026–27 fiscal year, which begins July 1.

Presented to the governor on March 18, the bill is expected by lawmakers to be signed possibly within days, though no timeline has been confirmed.

Disruption to ADAP began in January, when the Florida Department of Health (DOH) announced roughly $120 million in cuts to the program, citing higher insurance premiums and reduced federal funding. ADAP recipients received an ambiguously worded letter that many interpreted as indicating their insurance had been canceled, alongside notice of significant cutbacks. The state lowered ADAP’s income eligibility threshold from 400% of the federal poverty level (FPL) to 130%, reducing the qualifying annual income for an individual from about $62,600 to $20,345. (The current FPL is $15,650 for an individual.)

DOH also removed Biktarvy from the formulary and imposed restrictions on Descovy without clear transition guidance for recipients.

While HB 697 restores the 400% eligibility threshold on a temporary basis, it does not reinstate coverage for Biktarvy, lift restrictions on Descovy, or immediately restore premium assistance that many participants relied on. That funding may be addressed in the fiscal year 2026–27 budget, said Rachel Klein, deputy executive director of The AIDS Institute.

“Our hope is that they will restore premium assistance and the formulary, but we don’t know yet if that will happen,” she said.

For Floridians on Medicare or employer-based health plans, the bill directs DOH to assist with copays, allowing the agency to seek rebates to offset costs.

While the stopgap bill offers relief for many lower-income Floridians with HIV, it represents only a partial restoration of services. Many who find premiums unaffordable may need to consider lower-cost plans through the Affordable Care Act (ACA, also known as “Obamacare.”).

Klein addressed confusion stemming from the January DOH letter, noting that ADAP recipients’ insurance was not automatically canceled. Coverage generally remains active unless individuals discontinue it, in part because insurers continue receiving federal advance premium tax credits (APTCs) on behalf of enrollees.

“What changed is that ADAP stopped paying the remaining portion of the premium, at least for now,” Klein said. “As a result, clients now must decide whether to pay that remaining portion themselves, locate another source of assistance, switch plans, or cancel coverage.”

Approximately 80% of Florida ADAP clients receive APTCs under the ACA, and those credits have continued. However, beginning March 1, ADAP premium assistance ended. Even if enrollees could not pay their share, coverage typically remained active during a grace period. Claims are generally paid through the first month, after which insurers may hold—or “pend”—claims in subsequent months while waiting to see whether overdue premiums will be paid. If premiums are paid before the end of May, coverage returns to normal and pending claims should be covered. If premiums are not paid, insurers may cancel coverage retroactively to April 1.

It gets more complicated. Prescription claims cannot be “pended,” meaning pharmacies may deny meds during the April and May grace period. However, Florida ADAP is expected to continue covering some out-of-pocket costs, such as copays and deductibles, for insured clients with incomes up to 400% of FPL.

A special open enrollment period for Floridians on ADAP

Florida announced a “special enrollment period” for Florida ADAP clients who lost premium assistance, giving them until April 30 to shop for another, cheaper option for health insurance. 

“We want people to be mindful that because we don’t know what’s going to happen July 1, it makes sense to try to find another ADAP-approved plan if you can afford it and if your income is under 250% of the federal poverty level,” Klein said.

Klein has several recommendations for people who need to switch to an affordable plan: first, go to healthcare.gov and review all available plans, starting with the plans that are ADAP approved, and see what plans you can afford, with an emphasis on the silver plans. 

“Silver plans that are ADAP approved come with extra benefits for people who have low income, because they can lower out-of-pocket costs, deductibles, the out-of-pocket maximum and the co-pays.” The bronze plans, she notes, which may be cheaper upfront, often don't come with those extra protections, and typically have very high deductible and out-of-pocket costs, which could be onerous for someone who visits the doctor often and relies on prescription meds. Regarding meds, people should look at a plan’s formulary to make sure that the prescription drugs they need are covered. Make sure the doctor you want is in the provider network, Klein added.

When changing plans during the special open enrollment period, people will need to show that they have been denied their premium assistance, which should have been in the letter they received in January. They’ll have to show that letter to the healthcare.gov staff to be qualified for the special enrollment period. “If they didn't get that letter, or they have lost it, then they should talk to their caseworker to see if they can get a new copy,” Klein said. 

Reach out for help

If people are confused and frustrated by the process of changing their insurance plans, they should reach out for help, Klein said, starting with their case managers. 

“The caseworkers’ first priority should be making sure that you have continuous access to your treatment, whether that's through samples or if they if their pharmacy continues to have Biktarvy in stock or helping you decide what to do about your insurance, or helping you get on [Gilead’s] patient assistance program.”

Covering Florida, the state’s ACA navigator program, is developing tools for people affected by the loss of ADAP premium assistance and offers phone assistance at 877-813-9115.

The AIDS Institute also has compiled information to help people navigate the process of changing plans. These include a fact sheet about ADAP changes and how to spot junk insurance plans, which may show up as advertisements for plans not on the ACA Marketplace, the federal website used to enroll in health insurance plans created by the ACA.

“Some plans are called junk for a reason,” Klein said. “If it sounds too good to be true, it probably is.”

She emphasized that Marketplace plans include consumer protections not always found elsewhere, including limits on out-of-pocket costs and prohibitions on denying coverage or charging more based on pre-existing conditions.

“For example, the pre-existing condition exclusion, which means they can’t charge you more because you’re sick than they charge someone who’s healthy,” Klein said. “That’s not true in some market plans, which may have a lot of exclusions. Or they might have really small networks of providers that don’t include the providers that you use, and they don’t have the same kind of patient protections.”