ADAP Shortfall Relief - Project abstract Need Rebate forecasting indicates that the funding available for Minnesota’s HIV services will continue to be significantly reduced. At the same time, HIV diagnoses in Minnesota in 2024 remained near the ten-year high recorded in 2023, as the state continues to wind down its response to HIV outbreaks in Hennepin, Ramsey, and St. Louis counties. By maintaining the resources to fund Program HH (Minnesota’s ADAP program), the state’s efforts to increase healthcare utilization, retention in care, and treatment adherence will be significantly bolstered, thus fulfilling key components of the HIV Care Continuum. Proposed Services The proposed funding will address medication access, utilization, adherence, viral suppression, and overall quality of life. A top priority will be to continue ADAP services without introducing additional cost containment measures. DHS continues to explore paths for increasing program resources, finalizing its State Fiscal Year 2026 and 2027 budgets to determine funding available, and finalizing materials shared with the Minnesota Council on HIV/AIDS Care and Prevention, subrecipients, and other stakeholders. Securing additional resources aligns with Minnesota’s 2022-2026 Integrated Plan, which identified that reliance on special revenue such as 340B rebates represented a long-term risk for service stability. In addition to seeking Emergency Relief Funds (ERF) X09 funding, the State of Minnesota has increased annual funding for HIV services to account for some of these shortfalls. Minnesota’s HIV populations The Minnesota Department of Health reported 311 newly diagnosed HIV infections in 2024, which nearly equals the ten-year high of 324 reported in 2023. Nearly 10,000 people (9,826) are estimated to be diagnosed with HIV in Minnesota, with 1,100 people estimated to be unaware of their status. There are 5,704 (58%) Minnesotans diagnosed with HIV (non-AIDS), while 4,110 (42%) have an AIDS diagnosis. Most PWH live in the Twin Cities Metro area, with 2,913 (685.3 per 100,000) in Minneapolis; 1,085 (357.9 per 100,000) in St. Paul; 3,927 (162.2 per 100,000) in surrounding suburbs; and 1,889 (87.7 per 100,000) in Greater Minnesota. The majority of Minnesota’s PWH are male (7,319) compared to female (2,507). White, non-Hispanic persons comprise the majority of the state’s PWH (3,928). Black, non-African-born persons account for 1,987 cases while Black, African-born persons account for 1,123 of cases. Among Hispanic persons, 1,289 are known to be living with HIV, while American Indians account for 109 cases. Description of MN ADAP and key environmental factors impacting the program Program HH is housed and administered by the Minnesota Department of Human Services (DHS) within the HIV Supports Division (HSD) and includes several Ryan White Part B services as well as ADAP. Variances in received rebates and program expenditures have led to significant reductions in the resources available for HIV Supports. DHS’s ability to rebate on Medicare clients has also been limited, as the Part D drug maximum out-of-pocket cost has been capped at $2,000, resulting in a reduction of up to $3.5 million. At the same time, DHS is projecting a $3 million increase in ADAP/Health Insurance costs for the next grant year. Consequently, for SFY 2026, DHS has implemented a reduction in contracted services of $9.3 million, which will maintain resources for expected ADAP expenditures. This deficit would require another $6.5 million in cuts to core medical and supportive services, negatively impacting approximately 4,600 Minnesota Ryan White consumers while the state continues to wind down two identified HIV outbreaks. As a cost-cutting measure, DHS has applied a $15,000 cost ceiling, which will apply for all medications on formulary. Further cost-saving measures include enrolling eligible clients in health care coverage; enrolling eligible clients into Medicaid; and improved client eligibility confirmation processes.
