Stable Medicaid coverage reduced reliance on AIDS Drug Assistance Programs during COVID-19 | CROI 2026

Medicaid coverage provided during the COVID-19 public health emergency correlated with less reliance on AIDS Drug Assistance Programs (ADAPs), according to an abstract submitted to the Conference on Retroviruses and Opportunistic Infections (CROI) 2026, titled ‘Medicaid and State AIDS Drug Assistance Programs: The Impact of the Public Health Emergency.’ The poster was presented today by lead author Kathleen A. McManus, M.D., from the University of Virginia School of Medicine.

ADAPs are state-administered initiatives under the Ryan White HIV/AIDS Program that provide access to FDA-approved medications for low-income people with HIV who have limited or no health insurance.

Consistent access to antiretroviral therapy is essential for viral suppression and preventing transmission, and even short-term insurance disruptions can have significant public health consequences for individuals and communities. This is especially true for low-income populations relying on safety-net programs.

McManus and her colleagues used data from the NASTAD National ADP Monitoring Report Data from 2016 to 2023, an annual report that contains data on ADAP clients served by each state.

“Stable Medicaid coverage during the COVID-19 Public Health Emergency (PHE) reduced reliance on ADAP, particularly in Medicaid expansion states, while post-PHE disenrollment rapidly shifted coverage back onto ADAP, highlighting its critical role amid anticipated future Medicaid changes,” McManus and her colleagues write in the abstract.

Specifically, from 2017 to 2019, pre-COVID, ADAP enrollment increased in 38 states by an average of 19%. In expansion states, the increase was approximately 9%, and in non-expansion states, the increase was approximately 10%.

During COVID, which was from 2020 to 2022, ADAP enrollment decreased in 34 states with an approximate change of -11%, with expansion states dropping approximately 10% and non-expansion states only dropping 1%.

After COVID, from 2022 to 2023, ADAP enrollment increased approximately 6% in expansion states when compared with 10% in non-expansion states.

During the COVID-19 public health emergency, Medicaid eligibility redeterminations were suspended from 2020 until 2023 due to the Families First Coronavirus Response Act (FFCRA), which required Medicaid programs to keep enrollees enrolled through the end of the pandemic. This meant that millions of people retained their coverage. However, redeterminations resumed starting on April 1, 2023.

“These findings affirm ADAP's essential, counter-cyclical role in preserving access to care when primary insurance is lost. ADAPs need to have contingency plans for changes in Medicaid policy,” McManus writes. “Upcoming Medicaid policy changes, including more frequent redeterminations and eligibility restrictions, are likely to increase coverage churn and pressure on ADAPs.”

Upcoming Medicaid policy changes are the result of the One Big Beautiful Bill Act, signed into law in July 2025. The changes could result in an increase of uninsured individuals by 7.5 million by 2034 and approximately $1 trillion in federal funding cuts over the next decade, according to a Congressional Budget Office estimate. Changes also include national work or community service requirements for at least 80 hours a month and more frequent eligibility checks.

A $1.7 billion cut to domestic HIV program funding was recently blocked by Congress in the final FY2026 spending bill. In September 2025, the House Republicans proposed the cuts, which included a $525 million cut to the Ryan White HIV/AIDS program.