ADAP Shortfall Relief - Despite significant advancements in prevention and treatment that have drastically reduced new HIV infections and deaths, the ongoing effort to end the HIV epidemic faces critical challenges. A sustained response is essential, particularly given the stalling of progress in some regions and ongoing impact on vulnerable populations. For goals outlined in the United States “Ending the HIV Epidemic“ (EHE) Initiative, National HIV/AIDS Strategy, and the Ryan White Program 2030 vision to be realized, a renewed and multi-faceted approach is required. The challenges faced in Louisiana are many. America’s Health Rankings for 2023 rank Louisiana second in the nation for poverty rates with 19.4% living in poverty, compared to 12.7% nationally, and among the highest for proportion of population living in rural areas, with 29.1%, compared to 20.4% nationally. Likewise, the state ranks at the top for population in jails and prisons; the Vera Institute ranks Louisiana first in the nation for incarceration rates at 1,004 per 100,000 in 2024. Despite these challenges, Louisiana has made great strides in the HIV epidemic. Health insurance access, coverage, and maintenance efforts have facilitated substantial gains in HIV health outcomes throughout Louisiana, raising viral suppression among all people with HIV (PWH) by 15% between 2015 and 2024, and among PWH in care during the measurement year by 11%. The Louisiana AIDS Drug Assistance Program (ADAP), locally known as Louisiana Health Access Program (LA HAP), maintains high insurance rates among members. Among insured members, 88% are virally suppressed, compared to 80% among uninsured members; and among those in care during the measurement year, 95% are virally suppressed compared to 88% among uninsured members. To sustain and improve upon these gains, it is imperative that health insurance access, coverage, and maintenance, as well as medication access for the uninsured, remain stable. The current healthcare landscape changes have brought about a confluence of factors that threaten the HIV care system in concerning ways. Rising healthcare coverage costs, reductions in federal HIV funding, and changes to Medicaid all place additional pressure on LA HAP assistance to help with treatment access and maintaining people in care. This proposal supports Louisiana’s efforts to minimize implementation of ADAP cost-cutting measures, including a waitlist that could disrupt HIV healthcare and medication access for low-income individuals throughout the state, especially in rural areas. The Louisiana ADAP ERF Project: Maintaining Progress in Ending the HIV Epidemic synthesizes key strategies necessary for maintaining momentum and stabilizing the HIV care system including: dedicating all ADAP ERF funds to cover increases in health insurance premiums and medication cost-shares; expanding use of data analytics and stakeholder feedback to identify program efficiencies and for scenario planning to optimize cost-savings; limiting Marketplace plan choice for 2026 Open Enrollment to maximize cost-savings; prioritizing rebate use to sustain health insurance and medication access while balancing the need for other critical interventions along the HIV Care Continuum, such as linkage, engagement, and economic hardship; facilitating HIV care system access to alternative funding resources administered by the Louisiana Department of Health; and applying for as many additional Federal awards for which the program is eligible and within SHHP’s capacity to monitor and manage until the healthcare landscape stabilizes. The Louisiana Department of Health requests $7,000,000 for health insurance premiums and medication cost-shares to support LA HAP stability through funding and healthcare landscape changes. By carefully monitoring progress and adapting strategies, this project will provide a pathway to overcome present obstacles and ensure a sustainable response.
