ADAP Shortfall Relief - As of December 31, 2024, a cumulative total of 2,017 HIV infections had been reported to the Montana DPHHS since data collection began in 1985. Of those cases, 45% were Montana residents at the time of their diagnosis. More than 32% of all reported cases are known to have died from any cause. Table 3 summarizes characteristics of the 886 people living with HIV/AIDS in Montana as of December 2024. People living with HIV (PLWH) in Montana tend to be older than those newly diagnosed. In 2024, 22% of new diagnoses occurred among people aged 45 years and older, compared to 62% of all PLWH. New HIV diagnoses are not evenly distributed across Montana’s most populous counties. Yellowstone (21%), Missoula (18%), Gallatin (13%), and Cascade (10%) counties accounted for nearly two-thirds of new HIV diagnoses in 2024. The distribution of new HIV diagnoses by sex remained consistent between 2024 and the five-year average (2019–2023), with males comprising 89% of new cases. Men who reported sex with men (MSM) continue to represent the population most affected by HIV in Montana, accounting for 55% of new diagnoses. Among women, high-risk heterosexual contact (HRH)—defined as sexual contact with a person known to have, or to be at high risk for, HIV infection—was the leading transmission category, followed by injection drug use (IDU). From 2019 through 2023, an average of 21 people were newly diagnosed with HIV each year. In 2024, there were 27 new diagnoses, with men again representing 89% of those cases and more than half of that representation (55%) identified with MSM as at least one transmission risk. Most new diagnoses occurred among individuals aged 25–34 years (35%) and 15–24 years (25%). By comparison, most people living with HIV/AIDS (PLWHA) in Montana are older, with 64% aged 45 years or older. A diagnosis of Stage 3 HIV disease (AIDS) at the time of HIV detection indicates delayed diagnosis, which can postpone both partner notification and timely treatment initiation. From 2014 to 2024, Montana saw a substantial improvement, with the proportion of individuals diagnosed at Stage 3 HIV (AIDS) decreasing from 36% to 19% of all new cases. Montana’s ability to meet ADAP needs with existing resources is challenged by several key factors: 1.) A significant increase in ADAP costs due to rising insurance premiums and reductions in available premium tax credits; 2.) A decrease in Ryan White Part B Supplemental grant funding between FY 2024 and FY 2025; and 3.) An anticipated increase in the number of clients losing Medicaid coverage or becoming categorically ineligible for other health coverage. In FY 2024, the Montana ADAP served 294 clients—an increase from 233 in FY 2023. On average, 33 clients each month were uninsured, representing a substantial rise from previous years. Uninsured clients accounted for 58% of total ADAP expenditures. Insurance premiums and related costs are expected to more than double, particularly for individuals no longer eligible for premium tax credits, increasing total insurance costs from under $300,000 to nearly $500,000. Additionally, Montana received more than $600,000 less than anticipated from the Ryan White Supplemental Grant, making Emergency Relief Funding (ERF) essential to sustain services and prevent an ADAP waiting list. If awarded, including indirect costs, Montana will use ERF funds as follows: after indirect costs, Montana is requesting $296,340 to pay for full ADAP medications, $296,340 for the purchase of health insurance and $196,340 to cover medication co-payments, deductibles and/or co-insurance —totaling $800,000 for FY 2026.
