Palm Beach County asks state to reconsider ADAP changes and authorizes Ryan White funds to maintain HIV care
March 10, 2026 | Palm Beach County, Florida
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The Palm Beach County Board of County Commissioners on March 10 approved a resolution asking state officials to reconsider emergency changes to the Florida AIDS Drug Assistance Program and authorized county use of Ryan White program resources to preserve treatment access locally.
Dr. Casey Messer, program manager for HIV elimination services, told the board the state adopted an emergency rule effective March 1 that reduces income eligibility for ADAP from 400% of the federal poverty level to 130%, ends premium‑assistance pathways for insured clients, and removes Biktarvy — a widely used single‑pill regimen — from the program formulary. Messer said about 1,700 people in Palm Beach County could be affected.
"The elimination of that medication will require individuals who remain on this program to have their medication switched to other options," Messer said, noting many clients would face more complex, multi‑pill regimens.
Commissioners pressed staff on funding. Messer and other county officials said the local system faces an estimated annual impact of about $22,200,000 to cover gaps created by the state change, while the county receives roughly $7,600,000 annually in Ryan White Part A funds. Staff said the county will reconfigure services — including enrollment assistance and use of the federal 340B purchasing pathway — to generate program income that can be reinvested in sustaining care.
"We are notifying the clients directly," Messer said, describing outreach the county has already begun to people who lost ADAP coverage starting March 1.
Commissioner Bobby Powell urged urgency. "Because of these changes, people are going to die," he said, stressing the public‑health consequences of removing access to effective regimens. Other commissioners thanked staff and the HIV care council for developing a local plan quickly.
The board approved the resolution and associated implementation authority by unanimous vote. County staff said the resolution asks state leaders and the Department of Health to reconsider the changes, and authorizes shifting Ryan White funds and program structures so Palm Beach County can maintain medication access while the county pursues longer‑term solutions.
The county will continue direct client notifications, pursue 340B purchasing and insurance‑assistance models where feasible, and report back to the board on implementation details and funding assumptions.
Dr. Casey Messer, program manager for HIV elimination services, told the board the state adopted an emergency rule effective March 1 that reduces income eligibility for ADAP from 400% of the federal poverty level to 130%, ends premium‑assistance pathways for insured clients, and removes Biktarvy — a widely used single‑pill regimen — from the program formulary. Messer said about 1,700 people in Palm Beach County could be affected.
"The elimination of that medication will require individuals who remain on this program to have their medication switched to other options," Messer said, noting many clients would face more complex, multi‑pill regimens.
Commissioners pressed staff on funding. Messer and other county officials said the local system faces an estimated annual impact of about $22,200,000 to cover gaps created by the state change, while the county receives roughly $7,600,000 annually in Ryan White Part A funds. Staff said the county will reconfigure services — including enrollment assistance and use of the federal 340B purchasing pathway — to generate program income that can be reinvested in sustaining care.
"We are notifying the clients directly," Messer said, describing outreach the county has already begun to people who lost ADAP coverage starting March 1.
Commissioner Bobby Powell urged urgency. "Because of these changes, people are going to die," he said, stressing the public‑health consequences of removing access to effective regimens. Other commissioners thanked staff and the HIV care council for developing a local plan quickly.
The board approved the resolution and associated implementation authority by unanimous vote. County staff said the resolution asks state leaders and the Department of Health to reconsider the changes, and authorizes shifting Ryan White funds and program structures so Palm Beach County can maintain medication access while the county pursues longer‑term solutions.
The county will continue direct client notifications, pursue 340B purchasing and insurance‑assistance models where feasible, and report back to the board on implementation details and funding assumptions.
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