Introduction: From Safety Net to Cornerstone

NASTAD’s National Ryan White HIV/AIDS Program (RWHAP) Part B AIDS Drug Assistance Program (ADAP) Monitoring Project documents the pulse of a system essential to the Ending the HIV Epidemic (EHE) initiative. Passed by Congress and signed into law by President George H.W. Bush in 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was enacted to create and sustain a responsive care system that spans the continuum of HIV care.

The legislation charges RWHAP Part B programs—and specifically ADAPs—with a critical dual mandate: ensuring equitable access to life-saving therapeutics for low-income populations while adapting to the unique epidemiological needs of urban and rural regions alike. Administered by the Health Resources & Services Administration (HRSA) HIV/AIDS Bureau (HAB), the RWHAP was last reauthorized in 2009, with its authorization sunsetting on September 30, 2013. In the absence of Congressional action, the program continues to operate effectively through annual appropriations—a testament to its ongoing bipartisan support.

The FY2024 and CY2024 data included in this Annual Report reflect a dynamic year characterized by the unwinding of Medicaid continuous coverage, which began in April 2023, and shifting payer landscapes. Findings highlighted in this report are based on data received from 47 states, the District of Columbia, and Puerto Rico. The data illustrates that state and territorial ADAPs provide an indispensable safety net for people living with HIV/AIDS (PLWHA) who are under- or uninsured. However, this report must be read as a benchmark set against a darkening horizon. State and territorial ADAPs are facing an unprecedented fiscal storm. A wave of potential federal policy changes—including significant changes to Medicaid proposed in H.R. 1 and the expiration of enhanced Premium Tax Credits (ePTCs)—threatens to roll back the coverage gains that have kept people with HIV insured and in care.