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California State Legislature Reinvests AIDS Drug Assistance Program Rebates to Strengthen and Expand Critical HIV Services

The End the Epidemics coalition celebrates six years and over $160 million appropriated in successful budget advocacy, expanding programs to support Californians living with HIV and enhancing vital prevention strategies.

July 1, 2024 – On June 29, 2024, Governor Newsom signed the state budget for fiscal year 2024-25, including an expansion of the state’s AIDS Drug Assistance Program (ADAP) and associated programs and services advanced by the California Ending the Epidemics Coalition (EtE). This is a highly significant win, especially in a year where the state had to fill a $44.9 billion budget deficit with difficult budget solutions, including a $500 million loan from the ADAP Rebate Fund, a state special fund that covers medications, health care premiums, copays and coinsurance, and related services for treatment and prevention for uninsured and underinsured Californians living with and vulnerable to HIV.

“EtE is grateful to both the California State Legislature and the California Legislative LGBTQ+ Caucus for championing the EtE budget proposals in a very difficult fiscal environment,” says Laura Thomas, Senior Director of HIV and Harm Reduction Policy at the San Francisco AIDS Foundation. “We are also incredibly proud of our coalition for uplifting our stories throughout the budget process to convey to the legislature that the spread of HIV, STI, viral hepatitis, and overdose syndemic will only slow when the state adequately funds critical services focused on people facing the most barriers to quality prevention, care, and treatment.”

The EtE budget proposal maintains core ADAP services and increases investments in programs that support vulnerable communities, particularly people who use drugs (PWUD), people aging with HIV, and transgender, gender nonconforming, and intersex (TGI) people.

The following appropriations from the ADAP Rebate Fund will begin on July 1, 2024:

  • $10 million each year for three years for the harm reduction clearinghouse;
  • $5 million each year for three years for HIV services offered by TGI-led organizations;
  • $200,000 to assess and analyze the pre-exposure prophylaxis (PrEP Assistance Program; PrEP-AP) navigation and retention services;
  • $200,000 to assess and analyze the delivery of ADAP health care navigation and retention services; and,
  • $5 million for access to internal and external condoms available to public school pupils in grades 9 – 12.

The following ADAP modernizations will begin on January 1, 2025:

  • Increase income eligibility from 500% to 600% federal poverty level; and,
  • Increase the monthly cap on health care premium payment assistance from $1938 to $2996 for clients with commercial, employer-based, and Medicare plans.
  • Creation of an open formulary.

EtE also advocated for a restoration of funds to the California Overdose Prevention and Harm Reduction Initiative (COPHRI) from opioid settlement funds newly acquired by the Office of State Attorney General, Rob Bonta. The appropriation includes $1.1 million for the fiscal year 2024-25.

In addition to the expansions, EtE thanks the Legislature, particularly the LGBTQ+ caucus, for championing protective pay back guardrails for the loans taken from the ADAP rebate special fund. The 2024-25 budget includes commitments that the Administration will return borrowed funds as needed to maintain program operations, provide uninterrupted access to drugs and services, and expand current services and programs. The budget bill also requires the administration to pay interest on the loan to further incentivize repayment.

Coalition quotes:

“We’re taking today to celebrate and thank the people who championed these expansions knowing that ADAP is still capable of doing so much more,” says Sebastian Perez, End the Epidemics Policy Committee Co-Chair. “ADAP’s expansions certainly reflect EtE’s syndemic approach to care, and we must focus on reducing racial disparities in HIV acquisition, in particular. PrEP and PEP uptake among young Black and Latinx gay, bisexual, and men who have sex with men is lower than uptake among white men, and transgender women of color are still disproportionately vulnerable to HIV. EtE looks forward to working with state leadership to develop programs and services that effectively eliminate HIV from communities of color and other vulnerable communities.”

“The coalition applauds the Governor’s decision to expand ADAP programs,” said Anne Donnelly, State Health Care Policy Director at San Francisco AIDS Foundation “However, we remain concerned that the Governor borrowed $500 million from the ADAP special fund to help backfill the state budget deficit. The ADAP provides life-saving pharmaceuticals to populations highly impacted by HIV, including uninsured or underinsured individuals who have no other access to care. ADAP also supports health premium and co-pay assistance to public and privately insured individuals and has utilized the special fund to support a robust PrEP (pre- exposure prophylaxis) Assistance Program to those most at risk for HIV.”

“The California Syringe Exchange Programs (CASEP) Coalition is proud to be part of a historic coalition that came together to amplify the need for vital health services in communities disproportionately affected by HIV, HCV, STIs and overdoses – primarily Black, Indigenous and People of Color, LGBTQI+, sex workers, and unhoused Californians. We are honored to work with NHRC, Stop the Raids, and EtE, and all the passionate individuals that work tirelessly to create a healthier California for all people. Many thanks to the CA State Legislature for hearing us and funding this important work; we look forward to continuing to bring our communities compassion, dignity, and love.”

“Linkage to HIV care and access to Prepare two of the main pillars of the national End the HIV Epidemic effort,” said Craig E. Thompson, CEO of APLA Health. “APLA Health commends the state legislature for modernizing ADAP and will continue to advocate for expanding PrEP outreach and education to those communities most at risk of HIV. We clearly cannot end the HIV and other epidemics without making sure these ADAP programs do more to reach those who are least likely to know they are living with HIV and least likely to access PrEP to prevent acquiring the virus.”

“San Francisco AIDS Foundation extends our thanks to the California State Legislature, especially the LGBTQ+ caucus, and Governor Newsom for the investment in the expansion and maintenance of the ADAP and its associated services during this challenging budget year,” said Tyler TerMeer, CEO of SFAF. “Equally important is the statutory commitment that loaned ADAP funds will be returned to the special fund when or if they are needed to maintain or expand services. This critical funding will ensure that individuals living with and at risk for HIV will continue to have access to life-saving medications and essential treatments, particularly those in our communities who may face the greatest barriers to care.”

“The Los Angeles LGBT Center commends the California LGBTQ+ Caucus and State Legislature for prioritizing ending these epidemics statewide,” said Joey Espinoza-Hernandez, Director of Policy and Community Building at LA LGBT Center. “By championing vital ADAP expansions, we are working to ensure that Californians dependent on these programs can continue accessing the essential medications and treatment they need most. We extend our gratitude to Governor Newsom for the state’s prioritization of our communities’ health and wellbeing.” The National Harm Reduction Coalition extends gratitude to the California

“The National Harm Reduction Coalition (NHRC) extends gratitude to the California State Legislature for acknowledging and prioritizing vital health services by maintaining, restoring, and uplifting fiscal support while prioritizing the needs of its residents disproportionately affected by HIV, HCV, STIs and overdoses,” said Raven Hoopes, NHRC Capacity Building Manager. “More people survive, thrive, and avoid harms associated with this syndemic when our work is supported by appropriate funding and least barriers. Our state is only as healthy as we are willing to go in the direction of compassion and equitable access when preventing the spread of communicable diseases and employing harm reduction to save lives. NHRC sends kudos and big love out to all the individuals and programs that came together to rally for our communities continuously affected by these decisions, primarily Black, Indigenous and People of Color, LGBTQI+, sex workers, and unhoused Californians.”

“Stop the Raids was honored to participate in the End the Epidemics and CASEP Day of Action in Sacramento. It was a historic moment to have the HIV, Harm Reduction & Sex Worker Rights Communities together in collaboration to advocate for our most vulnerable people. Thank you to Sacramento leadership for listening to our concerns and supporting our efforts to end the epidemics and intersecting needs for our California community.”

About the California End the Epidemics Coalition

End the Epidemics: Mobilizing to End HIV, STIs, Viral Hepatitis, and Overdose is dedicated to advocating for anti-racist policies and funding priorities to eliminate health disparities that affect Black, Indigenous and People of Color (BIPOC) in our state. Since 2018, EtE has successfully advocated over $160 million from California’s legislature to fund programs and services that help stop this syndemic from spreading.

About the author

San Francisco AIDS Foundation

San Francisco AIDS Foundation promotes health, wellness and social justice for communities most impacted by HIV through sexual health and substance use services, advocacy, and community partnerships. Each year more than 21,000 people rely on SFAF programs and services, and millions more access SFAF health information online.