NASTAD 2020 Report

2020 Report  |  NASTAD.ORG

NASTAD logo

  1. 1RWHAP Part B Program Funding and Structure
  2. Overview of RWHAP Part B Program
  3. National RWHAP Part B Program Budget

  4. 2Effective and Comprehensive Care in Achieving an End to the HIV Epidemic (EHE)
  5. Overview of Jurisdictional and Federal EHE Efforts
  6. Who are RWHAP Part B Program Clients?

  7. 3Expanding and Adapting Service Delivery in a Changing Healthcare Landscape
  8. Capitalizing on opportunities to expand the reach and breadth of services
  9. Key Policy Changes’ Impact on RWHAP Part B and ADAP

2020 National RWHAP Part B and ADAP Monitoring Project Annual Report

scroll down the page

Summary

NASTAD’s National Ryan White HIV/AIDS Program (RWHAP) Part B and AIDS Drug Assistance Program (ADAP) Monitoring Project, including its Annual Report, documents key trends, challenges, and successes faced by public health programs ensuring access to life-saving treatment and services for people living with HIV (PLWH) nationally. In the 23rd year of its history, this 2020 edition of the Annual Report marks the second featuring comprehensive, longitudinal data spanning several domains of the RWHAP Part B program and ADAP, including budget, expenditures, utilization, and client demographics.

As in the iteration published in 2019, the National RWHAP Part B and ADAP Monitoring Survey and the resulting Annual Report reflect a relatively abbreviated snapshot of calendar year 2018 and fiscal year 2019, highlighting those data points that are most dynamic year-to-year, including budgets and expenditures, as well as client utilization and health outcomes (e.g., viral load suppression). As in previous years, the Annual Report also aims to illustrate the actual or potential impacts of key policies (e.g., federal/state changes to the Affordable Care Act (ACA) and Medicaid coverage) on RWHAP Part B programs’ and ADAPs’ effectiveness in delivering treatment and key support services for HIV and comorbid conditions that disproportionately impact PLWH.

RWHAP Part B programs and ADAPs provide an important safety net for PLWH who are under- or uninsured and are critical players in achieving the goals of the National HIV/AIDS Strategy (NHAS) as well as ending-the-epidemic (ETE) initiatives. Changes to the broader health care and payer landscape could significantly affect RWHAP Part B programs and ADAPs and their contributions to ETE efforts, including the federal Ending the HIV Epidemic: A Plan for America. This year’s iteration of the Annual Report reflects a baseline prior to the allocation of dedicated funding to RWHAP Part B programs and ADAPs enacting this initiative.

In FY2020, the President’s Budget requested $70 million for Ending the HIV Epidemic (EHE) Initiative funding for RWHAP Parts A and Part B. The 2020 National RWHAP Part B and ADAP Monitoring Project Annual Report does not including EHE funding, but future iterations will account for this funding, once it is allocated. This will provide important context for analyzing the impact of EHE funding on RWHAP Part B Programs. Eligible RWHAP Part B Programs that can receive EHE funding are Alabama, Arkansas, Kentucky, Mississippi, Missouri, Ohio, Oklahoma, and South Carolina.

Section One

RWHAP Part B Program Funding and Structure

Overview of RWHAP Part B Program

Passed by Congress and signed into law by President George H.W. Bush in 1990, the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act was enacted to create and sustain a responsive care system that spans the continuum of HIV care. This includes: HIV diagnosis; linkage to, and lifelong engagement in, HIV medical care and supportive services; access to safe, effective, and easy-to-use treatment; and durable virologic suppression. Administered by the Health Resources & Services Administration (HRSA) HIV/AIDS Bureau (HAB), the RWHAP was last reauthorized in 2009 and the most recent authorization sunset ended September 30, 2013. In the absence of Congressional action on authorization, the program continues to effectively operate as Congress maintains annual appropriations to it. RWHAP clients demonstrate higher outcomes across the HIV care continuum as compared to all PLWH; in 2018, 87% of clients receiving RWHAP medical services were virally suppressed.

The Part B program is the RWHAP component that ensures state and territorial health departments are funded to provide core medical and support services to eligible clients equitably across urban and rural regions. All 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the six U.S. Pacific Territories/Associated Jurisdictions are eligible to receive Part B program funding. Each jurisdiction’s RWHAP Part B program must customize their administration and service delivery to ensure that they are meeting the needs of the clients they serve as well as the political and structural environment in which they exist. All RWHAP Part B programs aim to guarantee access to treatments and services that bolster clients’ engagement and retention in care so as to ultimately optimize their viral suppression and their overall wellbeing. RWHAP Part B programs are comprised of the following key components: core medical/support service delivery; clinical quality management (i.e., a series of activities that focus on enhancing the quality of HIV care provided and increasing access to services); and program administration (i.e., administrative, planning and evaluation, salaries, overhead, client eligibility and enrollment, and data system management and reporting).

The breadth of core medical and support service categories allowable under RWHAP, including Part B, represent a wholistic approach to serving individuals with a chronic disease who experience complex social and structural barriers and/or comorbid conditions. Core medical services support eligible clients across the HIV-care continuum by bolstering testing, linkage to, and retention in care for HIV and comorbidities. Early Intervention Services (EIS), for example, aims to increase the proportion of PLWH who know their HIV-status and are linked to appropriate HIV care and other necessary core medical/support services. In 2018, 8,444 individuals were served via EIS in 2018 across 19 of 52 (37%) reporting Part B programs, as compared to 7,358 served in 2017 (15% increase) by 20 of 49 (41%) Part B programs. Other service categories such as Mental Health Services and Substance Use Treatment (Outpatient and Residential) are designed to support clients in accessing services to manage comorbid mental and behavioral health conditions that may impede their adherence to and effectiveness of treatment and care. Meanwhile, RWHAP support services (e.g., Housing Services, Medical Transportation Services) undergird these by ensuring adherence to and the effectiveness of clinical care. The array of RWHAP services ensures that public health priorities (e.g., minimizing new infections by optimizing viral load suppression) and individual clients’ overall health and wellness needs are simultaneously addressed.

ADAPs are a component part of the Part B program charged with ensuring access to lifesaving treatments for HIV (e.g., HIV antiretroviral (ARV) medications, “A1” opportunistic infection (OI) medications) and comorbid conditions that disproportionately impact PLWH and/or affect the adherence to or effectiveness of ARV treatment. ADAPs do so through two mechanisms: (1) by paying for the full, negotiated cost of medications for clients; and (2) by paying for a portion or all of a client’s premiums, co-payments, cost-sharing, and/or deductibles for private or public insurance. The Ryan White Comprehensive AIDS Resources Emergency (CARE) Act enables ADAPs to cover a broad array of medications within their formularies for insured and uninsured clients with a limited number of requirements (e.g., all medications and ancillary devices be Food & Drug Administration (FDA)-approved). ADAPs’ expansive medication coverage is critical to their success and consistent with overall goals of the RWHAP to be patient-centered and comprehensive.

With a December 2019 HRSA letter allowing the use of ADAP federal funding to cover the medical costs and insurance cost sharing associated with the administration of long-acting ARVs, ADAPs now have the flexibility to assume the full costs of provider-administered HIV treatments. However, ADAPs cannot always meet the entirety of clients’ medical needs on their own – ADAP federal funding generally may not be used to pay for medical costs. As a result, ADAPs must work in coordination with other RWHAP Part B services (e.g., Outpatient and Ambulatory Health Services and Health Insurance Premium and Cost-Sharing Assistance for Low-Income Individuals) and across all RWHAP Parts to provide the full complement of medical and non-medical services necessary to ADAP clients.

National RWHAP Part B Program Budget

Based on a formula and eligibility-based distribution mechanism, RWHAP Part B programs are eligible to receive the following categories of federal funding: Part B Base, Part B Supplemental (if applicable), Part B ADAP Earmark, Part B ADAP Supplemental (if applicable), and ADAP Emergency Relief Funding (if applicable). In FY2019, RWHAP Part B programs (n=59) were Congressionally appropriated a total of $1.3 billion, with $898 million (69%) awarded by HRSA to ADAP specifically (i.e., via Part B ADAP Earmark (n=59), Part B ADAP Supplemental (n=6), and ADAP Emergency Relief Funding (n=9)). By comparison, RWHAP Part B programs and ADAPs were awarded $1.4 billion and $893 million in FY2018, representing a -5% and 0.5% change for each. RWHAP was last reauthorized in 2009. In the absence of Congressional action on authorization, the program has and will continue to operate as Congress maintains annual appropriations to the program following the end of the most recent authorization sunset on September 30, 2013.

  View Larger

Chart 1

Total RWHAP Part B Budget, by Source, FY2017-FY2019

Total RWHAP Part B Budget, by Source, FY2017-FY2019

RWHAP Part B programs may choose to allocate a portion or all their Part B Base and/or Part B Supplemental to ADAP. For FY2019, 30 RWHAP Part B programs reported having allocated at least some portion of their RWHAP Part B Base and/or Part B Supplemental to ADAP, representing 5% of their overall ADAP budgets. As the largest component to the RWHAP Part B program with the greatest number of clients served (86%), ADAPs represented 71% of the overall Part B budget in FY2019. The proportion of the RWHAP Part B budget used for ADAP ranged from 0% in Federated States of Micronesia to 96% in Mississippi. Yet these awards alone do not meet the needs of RWHAP Part B programs or their clients. Instead, jurisdictions must often use other funding streams to sustain their infrastructure and service delivery.

RWHAP Part B programs must use at least 75% of federal RWHAP awards (e.g., Part B Base, Part B Supplemental) to fund core medical services, including ADAP (unless a “75/25 waiver” is approved by HRSA HAB). In 2019, 96% of all RWHAP Part B program expenditures were used for core medical services as compared to 86% in 2018. Part B programs may exceed the 75/25 requirement using non-federal funding including rebates or program income. Additional sources that may be available to RWHAP Part B programs include other federal funding (e.g., carry-over from prior Part B Base or ADAP Earmark awards), state general revenue funding, private donations, program income, and rebates received as part of medication purchasing. RWHAP Part A programs in eligible metropolitan areas may contribute direct-appropriated funds to their Part B counterparts. Such decisions are made locally and reflect an effort between RWHAP Parts A and B programs to avoid duplicating service delivery and to mutually ensure each other’s success in serving the needs of PLWH. Taken together, these additional funding sources make up 55% of the FY2019 RWHAP Part B program and ADAP budgets.

Rebates (41%), Part B ADAP earmark (28%), and Part B base (11%) make up the greatest proportions of the overall Part B budget for FY2019. Rebates, payments received by some ADAPs from pharmaceutical manufacturers after paying for medications for clients, are tracked separately from front-end discounts and account for both repayment to ADAP from a manufacturer for a drug expenditure and any additional savings generated. The total amount of rebates received as well as the proportion of the Part B budget they represented increased significantly between FY2018 and FY2018 FY2019 (i.e., from 32% to 41%). Of note, this is the first increase in the proportion rebates made up of the Part B budget since FY2016, the earliest year in which all portions of the Part B budget were gathered as part of the Annual Report. Between FY2016 and FY2018, the proportion of the Part B budget attributable to rebates decreased an average 2% per year. Further, for FY2019, the first year in which this Annual Report has gathered such data, $18.7 and $72.3 million were the amounts of program income used for 9 Part B programs and 6 ADAPs, respectively, representing 3% of the total Part B budget. Separately from rebates, ADAPs may also generate program income that may be used for allowable RWHAP services and activities, including ADAP. For example, an ADAP may bill third-party insurance for the usual and customary cost for medications sold to ADAP clients where the medications were purchased at 340B pricing.

Between 2016 and 2019, the RWHAP Part B program and ADAP budgets have each increased 11% and 2%, respectively. The Part B budget has increased an average 4% per year over this period whereas the ADAP budget has changed by 0.6% per year. Between 2013 and 2019, ADAPs specifically have reported significant shifts in their total budgets and subsequent expenditures as a result of expansions in ADAP-funded insurance and the migration of ADAP clients to Medicaid. ADAP-funded insurance is defined as when an ADAP client is enrolled in insurance (public or private insurance) and the ADAP pays for part or all the clients’ co-payments/co-insurance, deductibles, and/or premiums. ADAPs began purchasing insurance for clients in 2002 when HRSA HAB specifically clarified this option. In calendar year 2018, 50 ADAPs reported using funds for insurance purchasing/continuation (see Table 14), representing $558 million in estimated expenditures (27% of the total ADAP budget for the year) for 131,047 clients (54%), with an average cost per client of $4,259. By comparison, 44 ADAPs reported using funds for insurance purchasing/continuation in 2013 (i.e., the last year before the Patient Protection and Affordable Care Act (Affordable Care Act, ACA) was fully implemented) for 35% of all clients served by ADAP. From 2013 to 2018, ADAPs have reported an average 19% increase each year in the proportion of clients served by insurance purchasing/continuation programs. The ACA has enabled tens of thousands of PLWH, including those served by ADAP, to transition to expanded Medicaid and private insurance available through Marketplaces. ADAP continues to support more clients than ever to afford private insurance coverage.

  View Larger

Chart 2

Total ADAP Budget, by Source, FY1996-FY2019

Total ADAP Budget, by Source, FY1996-FY2019

Table 1

Scroll or click the table to use your arrow keys

State/Territory Part B FY2019 Total Budget ADAP FY2019 Total Budget % of Total Part B Budget
Alabama $45,125,137 $27,135,542 60%
Alaska $2,233,763 $573,082 26%
American Samoa $50,788 $788 2%
Arizona $43,619,842 $17,827,287 41%
Arkansas $18,769,201 $12,099,616 64%
California $239,378,224 $204,278,604 85%
Colorado $39,578,683 $22,998,610 58%
Connecticut $40,644,547 $31,962,670 79%
Delaware $9,999,224 $6,582,168 66%
District of Columbia $25,856,050 $18,397,106 71%
Federated States of Micronesia $50,000 $0 0%
Florida $295,857,193 $223,562,409 76%
Georgia $91,149,213 $68,485,830 75%
Guam $288,288 $88,288 31%
Hawaii $7,665,889 $2,852,167 37%
Idaho $10,403,156 $9,814,019 94%
Illinois $88,856,135 $70,449,325 79%
Indiana $37,747,664 $27,278,984 72%
Iowa $19,939,151 $8,583,318 43%
Kansas $7,774,856 $3,104,716 40%
Kentucky $17,845,582 $9,988,399 56%
Louisiana $53,041,972 $41,375,858 78%
Maine $5,650,333 $4,137,805 73%
Marshall Islands $50,788 $788 2%
Maryland $99,297,050 $55,673,318 56%
Massachusetts $42,521,744 $28,311,958 67%
Michigan $43,565,289 $22,865,990 52%
Minnesota $26,232,447 $12,191,348 46%
Mississippi $19,105,371 $18,405,371 96%
Missouri $61,248,643 $48,474,536 79%
Montana $2,616,942 $1,754,242 67%
Nebraska $18,617,191 $11,917,805 64%
Nevada $64,965,995 $22,714,820 35%
New Hampshire $3,205,073 $2,205,073 69%
New Jersey $99,737,358 $88,407,208 89%
New Mexico $7,887,555 $2,699,832 34%
New York $396,818,370 $366,020,844 92%
North Carolina $73,684,812 $57,264,975 78%
North Dakota $2,274,802 $1,702,902 75%
Northern Mariana Islands $64,093 $5,518 9%
Ohio $41,619,658 $21,494,555 52%
Oklahoma $17,141,376 $13,788,213 80%
Oregon $35,816,010 $6,574,705 18%
Pennsylvania $148,645,858 $118,345,516 80%
Puerto Rico $87,884,314 $38,234,377 44%
Republic of Palau $57,095 $7,095 12%
Rhode Island $13,270,236 $6,532,122 49%
South Carolina $66,942,350 $30,514,827 46%
South Dakota $4,830,168 $4,508,790 93%
Tennessee $58,138,129 $25,891,270 45%
Texas $182,830,983 $125,033,017 68%
Utah $13,578,296 $8,400,197 62%
Vermont $2,981,779 $1,506,138 51%
Virgin Islands (U.S.) $1,571,480 $755,012 48%
Virginia $74,993,074 $43,344,578 58%
Washington $48,074,386 $40,087,105 83%
West Virginia $6,220,090 $3,596,386 58%
Wisconsin $35,331,129 $22,720,591 64%
Wyoming $1,839,886 $999,886 54%
Total $2,905,184,711 $2,064,527,499 71%

Table 2

Scroll or click the table to use your arrow keys

State/Territory Total FY2019 Budget Part B Base Part B Base Contribution Allocated to Part B Part B Base Contribution Allocated to ADAP % of Total Budget Part B Supplemental1 Part B Supplemental Allocated to Part B Part B Supplemental Allocated to ADAP % of Total Budget Part B ADAP Earmark % of Total Budget Part B ADAP Supplemental2 % of Total Budget ADAP Emergency Funding % of Total Budget Part A TOTAL Part A Contribution Allocated to Part B Part A Contribution Allocated to ADAP % of Total Budget Part B State Contribution ADAP State Contribution % of Total Budget Part B Estimated Drug Rebates3 ADAP Estimated Drug Rebates3 % of Total Budget Part B Estimated Program Income ADAP Estimated Program Income % of Total Budget Part B Other State or Federal ADAP Other State or Federal % of Total Budget Total FY2018 Budget
Alabama $45,125,137 $8,100,933 $7,557,665 $543,268 18% $2,010,447 $0 $2,010,447 4% $10,470,766 23% $0 0% $0 0% $0 $0 $0 0% $0 $1,894,796 4% $10,115,665 $11,900,000 49% $0 $0 0% $316,265 $316,265 1% $45,125,137
Alaska $2,233,763 $500,000 $500,000 $0 22% $167,158 $167,158 $0 7% $573,082 26% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $0 $0 0% $365,223 $628,300 44% $0 $0 0% $2,233,763
American Samoa $50,788 $50,000 -- -- 98% $0 -- -- 0% $788 2% $0 0% $0 0% $0 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- $50,788
Arizona $43,619,842 $4,224,934 $4,224,934 $0 10% $3,367,621 $3,367,621 $0 8% $12,077,287 28% $0 0% $0 0% $0 $0 $0 0% $0 $750,000 2% $15,000,000 $5,000,000 46% $3,200,000 $0 7% $0 $0 0% $43,619,842
Arkansas $18,769,201 $3,431,552 $3,431,552 $0 18% $0 $0 $0 0% $4,547,606 24% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $2,000,000 $3,000,000 27% $0 $0 0% $1,238,033 $4,552,010 31% $18,769,201
California $239,378,224 $33,423,848 $33,423,848 $0 14% $6,375,772 $1,675,772 $4,700,000 3% $104,062,843 43% $0 0% $11,000,000 5% $0 $0 $0 0% $0 $0 0% $0 $81,203,873 34% $0 $0 0% $0 $3,311,888 1% $239,378,224
Colorado $39,578,683 $3,409,873 $3,409,873 $0 9% $0 $0 $0 0% $9,680,906 24% $0 0% $0 0% $0 $0 $0 0% $0 $8,404,826 21% $8,500,000 $4,600,000 33% $3,641,182 $0 9% $1,029,018 $312,878 3% $39,578,683
Connecticut $40,644,547 $2,699,111 $2,699,111 $0 7% $0 $0 $0 0% $8,582,828 21% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $3,283,665 $18,171,615 53% $0 $0 0% $2,699,101 $5,208,227 19% $40,644,547
Delaware $9,999,224 $1,990,013 $1,990,013 $0 20% $427,043 $427,043 $0 4% $2,572,168 26% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $1,000,000 $4,010,000 50% $0 $0 0% $0 $0 0% $9,999,224
District of Columbia $25,856,050 $3,527,427 $3,527,427 $0 14% $0 $0 $0 0% $10,408,704 40% $0 0% $0 0% $990,249 $0 $990,249 4% $3,930,647 $0 15% $0 $3,200,000 12% $0 $0 0% $870 $3,798,153 15% $25,856,050
Federated States of Micronesia $50,000 $50,000 -- -- 100% $0 -- -- 0% $0 0% $0 0% $0 0% $0 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- $50,000
Florida $295,857,193 $30,354,143 $0 $30,354,143 10% $5,919,497 $5,919,497 $0 2% $87,590,089 30% $0 0% $11,000,000 4% $0 $0 $0 0% $60,178,486 $6,000,000 22% $0 $86,750,439 29% $0 $0 0% $6,196,801 $1,867,738 3% $295,857,193
Georgia $91,149,213 $14,641,185 $14,641,185 $0 16% $3,185,196 $0 $3,185,196 3% $38,479,256 42% $9,500,000 10% $6,500,000 7% $0 $0 $0 0% $6,122,198 $10,621,514 18% $0 $0 0% $1,400,000 $500,000 2% $0 $199,864 0% $91,149,213
Guam $288,288 $200,000 $200,000 $0 69% $0 $0 $0 0% $88,288 31% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% 0% 0% 0% $288,288
Hawaii $7,665,889 $1,613,722 $1,613,722 $0 21% $0 $0 $0 0% $2,085,797 27% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $3,200,000 $0 42% $0 $0 0% $0 $766,370 10% $7,665,889
Idaho $10,403,156 $589,137 $589,137 $0 6% $2,362,242 $0 $2,362,242 23% $761,482 7% $600,000 6% $2,390,295 23% $0 $0 $0 0% $0 $400,000 4% $0 $3,300,000 32% $0 $0 0% $0 $0 0% $10,403,156
Illinois $88,856,135 $9,549,487 $8,917,972 $631,515 11% $0 $0 $0 0% $29,693,840 33% $6,000,000 7% $0 0% $0 $0 $0 0% $200,000 $15,535,162 18% $7,827,830 $18,588,808 30% $0 $0 0% $1,461,008 $0 2% $88,856,135
Indiana $37,747,664 $3,661,472 $0 $3,661,472 10% $4,910,680 $4,910,680 $0 13% $8,617,512 23% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $5,558,000 $15,000,000 54% $0 $0 0% $0 $0 0% $37,747,664
Iowa $19,939,151 $1,470,402 $200,000 $1,270,402 7% $4,640,925 $3,406,003 $1,234,922 23% $1,900,551 10% $0 0% $3,907,443 20% $0 $0 $0 0% $33,000 $20,000 0% $7,650,229 $250,000 40% $66,601 $0 0% $0 $0 0% $19,939,151
Kansas $7,774,856 $1,106,691 $1,106,691 $0 14% $3,563,449 $3,563,449 $0 46% $2,515,412 32% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $589,304 8% $7,774,856
Kentucky $17,845,582 $4,180,674 $4,180,674 $0 23% $0 $0 $0 0% $5,403,681 30% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $2,676,509 $2,676,509 30% $0 $0 0% $1,000,000 $1,908,209 16% $17,845,582
Louisiana $53,041,972 $6,566,114 $6,566,114 $0 12% $0 $0 $0 0% $17,205,858 32% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $5,100,000 $24,170,000 55% $0 $0 0% $0 $0 0% $53,041,972
Maine $5,650,333 $777,587 $672,875 $104,712 14% $766,952 $0 $766,952 14% $1,005,061 18% $0 0% $0 0% $0 $0 $0 0% $120,540 $45,861 3% $657,915 $2,099,408 49% $0 $0 0% $61,198 $115,811 3% $5,650,333
Marshall Islands $50,788 $50,000 -- -- 98% $0 -- -- 0% $788 2% $0 0% $0 0% $0 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- $50,788
Maryland $99,297,050 $7,823,385 $7,823,385 $0 8% $6,214,714 $6,214,714 $0 6% $25,662,560 26% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $29,343,243 $30,000,000 60% $0 $0 0% $242,390 $10,758 0% $99,297,050
Massachusetts $42,521,744 $5,194,169 $5,194,169 $0 12% $2,738,613 $1,870,000 $868,613 6% $15,745,957 37% $0 0% $0 0% $47,388 $0 $47,388 0% $2,945,617 $850,000 9% $4,200,000 $10,800,000 35% $0 $0 0% $0 $0 0% $42,521,744
Michigan $43,565,289 $5,108,493 $5,108,493 $0 12% $0 $0 $0 0% $13,401,603 31% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $15,590,806 $9,464,387 58% $0 $0 0% $0 $0 0% $43,565,289
Minnesota $26,232,447 $2,068,277 $2,068,277 $0 8% $2,282,268 $1,832,293 $449,975 9% $6,371,693 24% $0 0% $0 0% $0 $0 $0 0% $1,156,169 $1,063,678 8% $8,984,360 $4,306,002 51% $0 $0 0% $0 $0 0% $26,232,447
Mississippi $19,105,371 $5,876,638 $0 $5,876,638 31% $2,206,599 $0 $2,206,599 12% $7,822,134 41% $2,500,000 13% $0 0% $0 $0 $0 0% $700,000 $0 4% $0 $0 0% $0 $0 0% $0 $0 0% $19,105,371
Missouri $61,248,643 $3,519,801 $3,519,801 $0 6% $0 $0 $0 0% $10,157,817 17% $0 0% $0 0% $0 $0 $0 0% $6,838,809 $1,135,189 13% $0 $35,000,000 57% $0 $0 0% $2,415,497 $2,181,530 8% $61,248,643
Montana $2,616,942 $500,000 $128,719 $371,281 19% $388,101 $388,101 $0 15% $371,281 14% $0 0% $0 0% $0 $0 $0 0% $90,000 $30,000 5% $0 $612,911 23% $0 $0 0% $255,880 $368,769 24% $2,616,942
Nebraska $18,617,191 $1,259,386 $1,219,386 $40,000 7% $0 $0 $0 0% $1,627,805 9% $0 0% $0 0% $0 $0 $0 0% $0 $750,000 4% $480,000 $9,000,000 51% $0 $5,000,000 27% $0 $500,000 3% $18,617,191
Nevada $64,965,995 $2,251,175 $2,251,175 $0 3% $0 $0 $0 0% $6,914,820 11% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $40,000,000 $14,000,000 83% $0 $0 0% $0 $1,800,000 3% $64,965,995
New Hampshire $3,205,073 $275,060 $0 $275,060 9% $0 $0 $0 0% $826,355 26% $0 0% $0 0% $103,658 $0 $103,658 3% $0 $0 0% $1,000,000 $1,000,000 62% $0 $0 0% $0 $0 0% $3,205,073
New Jersey $99,737,358 $10,066,553 $10,066,553 $0 10% $1,263,597 $1,263,597 $0 1% $29,726,948 30% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $0 $58,680,260 59% $0 $0 0% $0 $0 0% $99,737,358
New Mexico $7,887,555 $1,858,281 $1,560,348 $297,933 24% $0 $0 $0 0% $2,401,899 30% $0 0% $0 0% $0 $0 $0 0% $1,785,200 $0 23% $0 $0 0% $1,842,175 $0 23% $0 $0 0% $7,887,555
New York $396,818,370 $33,082,619 $30,797,526 $2,285,093 8% $9,985,945 $0 $9,985,945 3% $101,488,310 26% $0 0% $0 0% $7,761,927 $0 $7,761,927 2% $0 $20,000,000 5% $0 $223,271,069 56% $0 $0 0% $0 $1,228,500 0% $396,818,370
North Carolina $73,684,812 $11,519,837 $11,519,837 $0 16% $2,762,432 $0 $2,762,432 4% $23,429,353 32% $0 0% $3,000,000 4% $0 $0 $0 0% $0 $14,336,118 19% $0 $10,237,072 14% $1,000,000 $0 1% $3,900,000 $3,500,000 10% $73,684,812
North Dakota $2,274,802 $500,000 $371,900 $128,100 22% $108,362 $0 $108,362 5% $266,440 12% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $200,000 $1,200,000 62% $0 $0 0% $0 $0 0% $2,274,802
Northern Mariana Islands $64,093 $50,000 -- -- 78% $8,575 -- -- 13% $5,518 9% $0 0% $0 0% $0 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- $64,093
Ohio $41,619,658 $7,221,439 $6,442,666 $778,773 17% $0 $0 $0 0% $17,305,181 42% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $13,682,437 $12,504 33% $0 $0 0% $0 $3,398,097 8% $41,619,658
Oklahoma $17,141,376 $3,644,596 $3,353,163 $291,433 21% $0 $0 $0 0% $4,710,780 27% $0 0% $0 0% $0 $0 $0 0% $0 $786,000 5% $0 $8,000,000 47% $0 $0 0% $0 $0 0% $17,141,376
Oregon $35,816,010 $41,305 $41,305 $0 0% $0 $0 $0 0% $4,074,705 11% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $0 $2,500,000 7% $7,200,000 $22,000,000 82% $0 $0 0% $35,816,010
Pennsylvania $148,645,858 $10,726,651 $0 $10,726,651 7% $0 $0 $0 0% $27,711,308 19% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $30,300,342 $70,876,978 68% $0 $0 0% $0 $9,030,579 6% $148,645,858
Puerto Rico $87,884,314 $5,655,258 $5,646,337 $8,921 6% $6,685,566 $0 $6,685,566 8% $14,667,586 17% $3,972,304 5% $11,000,000 13% $0 $0 $0 0% $0 $0 0% $0 $1,900,000 2% $3,600 $44,000,000 50% $0 $0 0% $87,884,314
Republic of Palau $57,095 $50,000 -- -- 88% $0 -- -- 0% $7,095 12% $0 0% $0 0% $0 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- $57,095
Rhode Island $13,270,236 $1,505,774 $972,723 $533,051 11% $1,625,709 $992,909 $632,800 12% $1,946,271 15% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $4,772,482 $3,420,000 62% $0 $0 0% $0 $0 0% $13,270,236
South Carolina $66,942,350 $10,270,867 $10,270,867 $0 15% $5,946,187 $5,946,187 $0 9% $13,526,940 20% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $18,555,869 $16,987,887 53% $0 $0 0% $1,654,600 $0 2% $66,942,350
South Dakota $4,830,168 $500,000 $321,378 $178,622 10% $0 $0 $0 0% $429,614 9% $0 0% $1,089,554 23% $0 $0 $0 0% $0 $0 0% $0 $2,750,000 57% $0 $0 0% $0 $61,000 1% $4,830,168
Tennessee $58,138,129 $4,963,282 $4,963,282 $0 9% $0 $0 $0 0% $13,417,368 23% $0 0% $0 0% $0 $0 $0 0% $0 $9,190,325 16% $24,000,000 $0 41% $0 $0 0% $3,283,577 $3,283,577 11% $58,138,129
Texas $182,830,983 $24,201,455 $24,201,455 $0 13% $0 $0 $0 0% $69,178,158 38% $15,000,000 8% $0 0% $350,668 $0 $350,668 0.2% $16,185,616 $30,504,191 26% $16,000,000 $10,000,000 14% $0 $0 0% $1,410,895 $0 1% $182,830,983
Utah $13,578,296 $1,780,827 $1,725,798 $55,029 13% $1,027,268 $852,788 $174,480 8% $2,301,787 17% $0 0% $1,322,937 10% $0 $0 $0 0% $0 $0 0% $2,599,513 $3,564,380 45% $0 $0 0% $0 $981,584 7% $13,578,296
Vermont $2,981,779 $500,000 $500,000 $0 17% $329,891 $329,891 $0 11% $403,601 14% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $645,750 $1,102,537 59% $0 $0 0% $0 $0 0% $2,981,779
Virgin Islands (U.S.) $1,571,480 $342,169 $94,681 $247,488 22% $0 $0 $0 0% $368,506 23% $0 0% $0 0% $0 $0 $0 0% $62,000 $18,000 5% $501,956 $0 32% $0 $0 0% $157,831 $121,018 18% $1,571,480
Virginia $74,993,074 $6,965,287 $6,965,287 $0 9% $0 $0 $0 0% $17,978,375 24% $0 0% $0 0% $0 $0 $0 0% $93,626 $237,812 0.4% $22,601,793 $13,539,755 48% $0 $200,000 0.3% $1,787,790 $11,588,636 18% $74,993,074
Washington $48,074,386 $3,637,552 $3,351,493 $286,059 8% $3,691,384 $3,691,384 $0 8% $10,012,773 21% $0 0% $0 0% $0 $0 $0 0% $944,404 $0 2% $0 $29,788,273 62% $0 $0 0% $0 $0 0% $48,074,386
West Virginia $6,220,090 $1,005,628 $0 $1,005,628 16% $2,623,704 $2,623,704 $0 42% $1,407,086 23% $0 0% $0 0% $0 $0 $0 0% $0 $0 0% $0 $1,183,672 19% $0 $0 0% $0 $0 0% $6,220,090
Wisconsin $35,331,129 $3,616,794 $3,616,794 $0 10% $2,041,035 $2,041,035 $0 6% $4,698,956 13% $0 0% $0 0% $0 $0 $0 0% $4,000,040 $1,306,200 15% $2,722,886 $16,457,304 54% $0 $0 0% $229,783 $258,131 1% $35,331,129
Wyoming $1,839,886 $500,000 $500,000 $0 27% $0 $0 $0 0% $249,886 14% $0 0% $0 0% $0 $0 $0 0% $140,000 $250,000 21% $200,000 $500,000 38% $0 $0 0% $0 $0 0% $1,839,886
Total $2,905,184,711 $314,250,863 $254,049,591 $59,951,272 11% $89,626,932 $51,483,826 $38,134,531 3% $808,941,062 28% $37,572,304 1% $51,210,229 2% $9,253,890 $0 $9,253,890 0.3% $105,526,352 $124,129,672 8% $308,951,250 $874,075,643 41% $18,718,781 $72,328,300 3% $29,340,537 $61,258,896 3% $2,905,184,711

Table 3

Scroll or click the table to use your arrow keys

State/Territory Part B FY2018 Total Budget Part B FY2019 Total Budget % Change ADAP FY2018 Total Budget ADAP FY2019 Total Budget % Change
Alabama $44,591,407 $45,125,137 1% $33,482,585 $27,135,542 -19%
Alaska $1,781,690 $2,233,763 25% $594,859 $573,082 -4%
American Samoa $32,908 $50,788 54% $815 $788 -3%
Arizona $30,987,103 $43,619,842 41% $14,873,459 $17,827,287 20%
Arkansas $17,165,912 $18,769,201 9% $6,052,010 $12,099,616 100%
California $253,737,043 $239,378,224 -6% $213,810,204 $204,278,604 -4%
Colorado $31,117,122 $39,578,683 27% $18,583,455 $22,998,610 24%
Connecticut $35,962,007 $40,644,547 13% $29,062,043 $31,962,670 10%
Delaware $10,692,646 $9,999,224 -6% $7,665,049 $6,582,168 -14%
District of Columbia $18,950,006 $25,856,050 36% $15,019,359 $18,397,106 22%
Federated States of Micronesia $50,815 $50,000 -2% $815 $0 -100%
Florida $246,068,570 $295,857,193 20% $150,515,812 $223,562,409 49%
Georgia $85,019,897 $91,149,213 7% $64,484,912 $68,485,830 6%
Guam $265,180 $288,288 9% $65,180 $88,288 35%
Hawaii $5,913,247 $7,665,889 30% $2,155,830 $2,852,167 32%
Idaho $10,062,447 $10,403,156 3% $8,141,593 $9,814,019 21%
Illinois $64,551,546 $88,856,135 38% $50,555,012 $70,449,325 39%
Indiana $54,151,392 $37,747,664 -30% $26,364,704 $27,278,984 3%
Iowa $21,019,207 $19,939,151 -5% $5,349,808 $8,583,318 60%
Kansas $4,123,165 $7,774,856 89% $2,903,033 $3,104,716 7%
Kentucky $11,900,646 $17,845,582 50% $5,378,982 $9,988,399 86%
Louisiana $66,934,145 $53,041,972 -21% $47,921,588 $41,375,858 -14%
Maine $4,903,752 $5,650,333 15% $3,827,610 $4,137,805 8%
Marshall Islands $27,021 $50,788 88% $815 $788 -3%
Maryland $102,959,594 $99,297,050 -4% $60,858,411 $55,673,318 -9%
Massachusetts $38,963,129 $42,521,744 9% $25,074,896 $28,311,958 13%
Michigan $46,490,914 $43,565,289 -6% $24,079,445 $22,865,990 -5%
Minnesota $29,693,746 $26,232,447 -12% $11,521,173 $12,191,348 6%
Mississippi $18,508,035 $19,105,371 3% $8,519,160 $18,405,371 116%
Missouri $50,850,384 $61,248,643 20% $40,370,440 $48,474,536 20%
Montana $2,783,621 $2,616,942 -6% $2,064,636 $1,754,242 -15%
Nebraska $17,620,988 $18,617,191 6% $14,751,760 $11,917,805 -19%
Nevada $39,338,884 $64,965,995 65% $32,294,547 $22,714,820 -30%
New Hampshire $5,582,173 $3,205,073 -43% $4,082,173 $2,205,073 -46%
New Jersey $110,066,641 $99,737,358 -9% $86,505,884 $88,407,208 2%
New Mexico $6,268,240 $7,887,555 26% $2,728,967 $2,699,832 -1%
New York $479,495,759 $396,818,370 -17% $447,649,130 $366,020,844 -18%
North Carolina $72,512,936 $73,684,812 2% $57,517,872 $57,264,975 -0.4%
North Dakota $2,681,699 $2,274,802 -15% $1,740,351 $1,702,902 -2%
Northern Mariana Islands $64,552 $64,093 -1% $4,074 $5,518 35%
Ohio $56,042,882 $41,619,658 -26% $30,920,178 $21,494,555 -30%
Oklahoma $23,115,410 $17,141,376 -26% $20,136,723 $13,788,213 -32%
Oregon $8,536,947 $35,816,010 320% $7,391,761 $6,574,705 -11%
Pennsylvania $104,038,654 $148,645,858 43% $77,506,654 $118,345,516 53%
Puerto Rico $59,910,961 $87,884,314 47% $53,038,167 $38,234,377 -28%
Republic of Palau $24,596 $57,095 132% $4,147 $7,095 71%
Rhode Island $13,334,841 $13,270,236 -0.5% $10,530,603 $6,532,122 -38%
South Carolina $82,622,233 $66,942,350 -19% $58,035,479 $30,514,827 -47%
South Dakota $3,439,965 $4,830,168 40% $2,208,288 $4,508,790 104%
Tennessee $68,430,785 $58,138,129 -15% $63,176,889 $25,891,270 -59%
Texas $140,558,914 $182,830,983 30% $99,327,787 $125,033,017 26%
Utah $13,513,735 $13,578,296 0.5% $8,385,172 $8,400,197 0.2%
Vermont $2,179,375 $2,981,779 37% $1,157,375 $1,506,138 30%
Virgin Islands (U.S.) $2,036,540 $1,571,480 -23% $1,138,196 $755,012 -34%
Virginia $85,285,801 $74,993,074 -12% $52,800,805 $43,344,578 -18%
Washington $50,873,350 $48,074,386 -6% $30,165,431 $40,087,105 33%
West Virginia $7,705,874 $6,220,090 -19% $4,822,361 $3,596,386 -25%
Wisconsin $32,134,159 $35,331,129 10% $21,672,626 $22,720,591 5%
Wyoming $1,473,387 $1,839,886 25% $903,387 $999,886 11%
Total $2,799,148,578 $2,905,184,711 4% $2,069,894,480 $2,064,527,499 -0.3%
Comparison Total 1 $2,798,683,506 $2,904,623,659 4% $2,069,818,634 $2,064,425,022 -0.3%

Table 4

Scroll or click the table to use your arrow keys

State/Territory 2018 Part B Base Contribution Allocated to Part B 2019 Part B Base Contribution Allocated to Part B % Change 2018 Part B Base Contribution Allocated to ADAP 2019 Part B Base Contribution Allocated to ADAP % Change 2018 Part B Supplemental Directed to Part B 2019 Part B Supplemental Directed to Part B % Change 2018 Part B Supplemental Directed to ADAP 2019 Part B Supplemental Directed to ADAP % Change 2018 Part B ADAP Earmark 2019 Part B ADAP Earmark % Change 2018 Part B ADAP Supplemental 2019 Part B ADAP Supplemental1 % Change 2018 ADAP Emergency Funding 2019 ADAP Emergency Funding % Change 2018 Part A Contribution Allocated to Part B 2019 Part A Contribution Allocated to Part B % Change 2018 Part A Contribution Allocated to ADAP 2019 Part A Contribution Allocated to ADAP % Change Part B 2018 State Contribution Part B 2019 State Contribution % Change ADAP 2018 State Contribution ADAP 2019 State Contribution % Change Part B 2018 Estimated Drug Rebates2 Part B 2019 Estimated Drug Rebates2 % Change 2013 total ADAP 2019 Estimated Drug Rebates2 % Change
Alabama $7,791,814 $7,557,665 -3% $268,363 $543,268 102% $2,500,000 $0 -100% $9,835,911 $2,010,447 -80% $10,594,199 $10,470,766 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $500,000 $0 -100% $2,419,796 $1,894,796 -22% $0 $10,115,665 100% $10,000,000 $11,900,000 19%
Alaska $500,000 $500,000 0% $0 $0 0% $425,451 $167,158 -61% $0 $0 0% $580,102 $573,082 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0%
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- $815 $788 -3% $0 $0 0% $0 $0 0% -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona $4,113,644 $4,224,934 3% $0 $0 0% $0 $3,367,621 100% $0 $0 0% $12,000,459 $12,077,287 1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $873,000 $750,000 -14% $12,000,000 $15,000,000 25% $2,000,000 $5,000,000 150%
Arkansas $3,374,295 $3,431,552 2% $0 $0 0% $0 $0 0% $0 $0 0% $4,552,010 $4,547,606 -0.1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $2,000,000 $2,000,000 0% $1,000,000 $3,000,000 200%
California $33,135,968 $33,423,848 1% $0 $0 0% $6,790,871 $1,675,772 -75% $16,975,000 $4,700,000 -72% $105,659,276 $104,062,843 -2% $0 $0 0% $11,000,000 $11,000,000 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $78,146,342 $81,203,873 4%
Colorado $3,362,667 $3,409,873 1% $0 $0 0% $0 $0 0% $0 $0 0% $9,768,043 $9,680,906 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $4,160,614 $8,404,826 102% $8,200,000 $8,500,000 4% $4,514,798 $4,600,000 2%
Connecticut $2,728,988 $2,699,111 -1% $0 $0 0% $0 $0 0% $0 $0 0% $8,869,373 $8,582,828 -3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $898,828 $0 -100% $0 $0 0% $3,272,148 $3,283,665 0.4% $20,192,670 $18,171,615 -10%
Delaware $2,027,597 $1,990,013 -2% $0 $0 0% $0 $427,043 100% $0 $0 0% $2,665,049 $2,572,168 -3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $1,000,000 $1,000,000 0% $5,000,000 $4,010,000 -20%
District of Columbia $0 $3,527,427 0% $3,718,903 $0 -100% $0 $0 0% $0 $0 0% $6,300,456 $10,408,704 65% $0 $0 0% $0 $0 0% $0 $0 0% $0 $990,249 100% $3,930,647 $3,930,647 0% $0 $0 0% $0 $0 0% $2,500,000 $3,200,000 28%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- $815 $0 -100% $0 $0 0% $0 $0 0% -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida $30,367,329 $0 -100% $0 $30,354,143 100% $20,900,239 $5,919,497 -72% $0 $0 0% $89,515,812 $87,590,089 -2% $0 $0 0% $0 $11,000,000 100% $0 $0 0% $0 $0 0% $31,642,087 $60,178,486 90% $6,300,000 $6,000,000 -5% $6,655,600 $0 -100% $75,581,323 $86,750,439 15%
Georgia $13,986,055 $14,641,185 5% $0 $0 0% $0 $0 0% $2,060,818 $3,185,196 55% $37,634,950 $38,479,256 2% $8,934,091 $9,500,000 6% $5,261,556 $6,500,000 24% $0 $0 0% $0 $0 0% $6,548,930 $6,122,198 -7% $10,297,357 $10,621,514 3% $0 $0 0% $0 $0 0%
Guam -- $200,000 -- -- $0 -- -- $0 -- -- $0 -- $65,180 $88,288 35% $0 $0 0% $0 $0 0% -- $0 -- -- $0 -- -- $0 -- -- $0 -- -- $0 -- -- $0 --
Hawaii $1,640,178 $1,613,722 -2% $0 $0 0% $0 $0 0% $0 $0 0% $2,155,830 $2,085,797 -3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $2,117,239 $3,200,000 51% $0 $0 0%
Idaho $577,100 $589,137 2% $0 $0 0% $1,343,754 $0 -100% $1,590,965 $2,362,242 48% $758,533 $761,482 0.4% $400,000 $600,000 50% $1,290,295 $2,390,295 85% $0 $0 0% $0 $0 0% $0 $0 0% $801,800 $400,000 -50% $0 $0 0% $3,300,000 $3,300,000 0%
Illinois $9,546,822 $8,917,972 -7% $0 $631,515 100% $0 $0 0% $0 $0 0% $30,334,787 $29,693,840 -2% $2,669,140 $6,000,000 125% $0 $0 0% $0 $0 0% $0 $0 0% $0 $200,000 100% $10,000,000 $15,535,162 55% $4,449,712 $7,827,830 76% $7,550,288 $18,588,808 146%
Indiana $3,609,343 $0 -100% $0 $3,661,472 100% $11,509,813 $4,910,680 -57% $0 $0 0% $8,643,687 $8,617,512 -0.3% $2,721,017 $0 -100% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $12,000,000 $5,558,000 -54% $15,000,000 $15,000,000 0%
Iowa $0 $200,000 100% $1,438,100 $1,270,402 -12% $8,797,941 $3,406,003 -61% $1,962,500 $1,234,922 -37% $1,890,221 $1,900,551 1% $0 $0 0% $0 $3,907,443 100% $0 $0 0% $0 $0 0% $0 $33,000 100% $58,987 $20,000 -66% $6,871,458 $7,650,229 11% $0 $250,000 100%
Kansas $1,095,007 $1,106,691 1% $0 $0 0% $0 $3,563,449 100% $0 $0 0% $2,539,577 $2,515,412 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $125,125 $0 -100% $0 $0 0% $0 $0 0% $0 $0 0%
Kentucky $4,092,386 $4,180,674 2% $0 $0 0% $0 $0 0% $0 $0 0% $5,378,982 $5,403,681 0.5% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $2,676,509 100% $0 $2,676,509 100%
Louisiana $4,942,557 $6,566,114 33% $1,534,000 $0 -100% $0 $0 0% $0 $0 0% $17,387,588 $17,205,858 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $14,070,000 $5,100,000 -64% $29,000,000 $24,170,000 -17%
Maine $642,442 $672,875 5% $144,174 $104,712 -27% $0 $0 0% $1,627,018 $766,952 -53% $1,033,918 $1,005,061 -3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $33,700 $120,540 258% $22,500 $45,861 104% $400,000 $657,915 64% $1,000,000 $2,099,408 110%
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- $815 $788 -3% $0 $0 0% $0 $0 0% -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland $7,975,128 $7,823,385 -2% $0 $0 0% $0 $6,214,714 100% $0 $0 0% $26,740,923 $25,662,560 -4% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $31,324,033 $29,343,243 -6% $20,000,000 $30,000,000 50%
Massachusetts $5,204,324 $5,194,169 -0.2% $0 $0 0% $940,000 $1,870,000 99% $4,164,136 $868,613 -79% $16,095,394 $15,745,957 -2% $0 $0 0% $0 $0 0% $0 $0 0% $47,388 $47,388 0% $3,543,909 $2,945,617 -17% $1,467,978 $850,000 -42% $4,200,000 $4,200,000 0% $3,300,000 $10,800,000 227%
Michigan $5,067,469 $5,108,493 1% $0 $0 0% $0 $0 0% $0 $0 0% $13,579,445 $13,401,603 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $15,590,806 100% $10,500,000 $9,464,387 -10%
Minnesota $1,723,300 $2,068,277 20% $319,912 $0 -100% $1,544,086 $1,832,293 19% $725,377 $449,975 -38% $6,444,676 $6,371,693 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $1,156,169 $1,156,169 0% $1,063,678 $1,063,678 0% $8,399,018 $8,984,360 7% $2,967,530 $4,306,002 45%
Mississippi $5,778,432 $0 -100% $0 $5,876,638 100% $3,510,443 $0 -100% $0 $2,206,599 100% $7,819,160 $7,822,134 0.04% $0 $2,500,000 100% $0 $0 0% $0 $0 0% $0 $0 0% $700,000 $700,000 0% $700,000 $0 -100% $0 $0 0% $0 $0 0%
Missouri $3,486,897 $3,519,801 1% $0 $0 0% $589,105 $0 -100% $0 $0 0% $10,281,335 $10,157,817 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $6,786,505 $6,838,809 1% $0 $1,135,189 100% $0 $0 0% $29,500,000 $35,000,000 19%
Montana $355,176 $128,719 -64% $144,824 $371,281 156% $202,298 $388,101 92% $364,193 $0 -100% $364,193 $371,281 2% $0 $0 0% $895,285 $0 -100% $0 $0 0% $0 $0 0% $36,447 $90,000 147% $46,337 $30,000 -35% $0 $0 0% $249,804 $612,911 145%
Nebraska $1,202,221 $1,219,386 1% $40,000 $40,000 0% $1,317,007 $0 -100% $0 $0 0% $1,632,760 $1,627,805 -0.3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $750,000 $750,000 0% $350,000 $480,000 37% $4,000,000 $9,000,000 125%
Nevada $2,187,045 $2,251,175 3% $0 $0 0% $0 $0 0% $0 $0 0% $6,855,310 $6,914,820 1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $2,260,589 $0 -100% $0 $0 0% $2,596,703 $40,000,000 1440% $11,188,876 $14,000,000 25%
New Hampshire $500,000 $0 -100% $0 $275,060 100% $0 $0 0% $0 $0 0% $978,515 $826,355 -16% $0 $0 0% $0 $0 0% $0 $0 0% $103,658 $103,658 0% $0 $0 0% $0 $0 0% $1,000,000 $1,000,000 0% $3,000,000 $1,000,000 -67%
New Jersey $10,105,758 $10,066,553 -0.4% $0 $0 0% $754,999 $1,263,597 67% $0 $0 0% $30,505,884 $29,726,948 -3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $12,700,000 $0 -100% $56,000,000 $58,680,260 5%
New Mexico $1,549,073 $1,560,348 1% $299,381 $297,933 -0.5% $0 $0 0% $0 $0 0% $2,429,586 $2,401,899 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $1,990,200 $1,785,200 -10% $0 $0 0% $0 $0 0% $0 $0 0%
New York $31,846,629 $30,797,526 -3% $2,265,271 $2,285,093 1% $0 $0 0% $26,333,142 $9,985,945 -62% $106,716,823 $101,488,310 -5% $0 $0 0% $0 $0 0% $0 $0 0% $14,884,391 $7,761,927 -48% $0 $0 0% $20,000,000 $20,000,000 0% $0 $0 0% $153,799,470 $223,271,069 45%
North Carolina $11,495,064 $11,519,837 0.2% $0 $0 0% $0 $0 0% $2,612,392 $2,762,432 6% $23,827,375 $23,429,353 -2% $0 $0 0% $3,000,000 $3,000,000 0% $0 $0 0% $0 $0 0% $0 $0 0% $14,341,033 $14,336,118 -0.03% $0 $0 0% $10,237,072 $10,237,072 0%
North Dakota $500,000 $371,900 -26% $0 $128,100 100% $161,348 $0 -100% $0 $108,362 100% $240,351 $266,440 11% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $280,000 $200,000 -29% $1,500,000 $1,200,000 -20%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- $4,074 $5,518 35% $0 $0 0% $0 $0 0% -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio $7,122,704 $6,442,666 -10% $0 $778,773 100% $0 $0 0% $0 $0 0% $17,420,178 $17,305,181 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $12,000,000 $13,682,437 14% $8,000,000 $12,504 -100%
Oklahoma $2,978,687 $3,353,163 13% $620,282 $291,433 -53% $0 $0 0% $0 $0 0% $4,730,441 $4,710,780 -0.4% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $786,000 $786,000 0% $0 $0 0% $8,000,000 $8,000,000 0%
Oregon $1,145,186 $41,305 -96% $0 $0 0% $0 $0 0% $0 $0 0% $4,891,761 $4,074,705 -17% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $2,500,000 $2,500,000 0%
Pennsylvania $0 $0 0% $10,617,820 $10,726,651 1% $0 $0 0% $0 $0 0% $28,064,078 $27,711,308 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $26,532,000 $30,300,342 14% $20,000,000 $70,876,978 254%
Puerto Rico $5,729,618 $5,646,337 -1% $28,358 $8,921 -69% $0 $0 0% $14,277,230 $6,685,566 -53% $15,260,275 $14,667,586 -4% $3,972,304 $3,972,304 0% $11,000,000 $11,000,000 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $3,500,000 $1,900,000 -46%
Republic of Palau -- -- -- -- -- -- $0 -- -- -- -- -- $4,147 $7,095 71% $0 $0 0% $0 $0 0% -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island $0 $972,723 0% $1,525,502 $533,051 -65% $1,305,974 $992,909 -24% $1,200,000 $632,800 -47% $2,005,101 $1,946,271 -3% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $4,772,482 100% $5,800,000 $3,420,000 -41%
South Carolina $3,390,463 $10,270,867 203% $6,779,553 $0 -100% $5,000,000 $5,946,187 19% $7,038,386 $0 -100% $13,616,923 $13,526,940 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $5,500,000 $0 -100% $16,196,291 $18,555,869 15% $9,794,347 $16,987,887 73%
South Dakota $415,767 $321,378 -23% $84,233 $178,622 112% $0 $0 0% $0 $0 0% $439,965 $429,614 -2% $0 $0 0% $0 $1,089,554 100% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $815,910 $0 -100% $1,684,090 $2,750,000 63%
Tennessee $5,053,896 $4,963,282 -2% $0 $0 0% $0 $0 0% $0 $0 0% $14,041,408 $13,417,368 -4% $0 $0 0% $9,000,000 $0 -100% $0 $0 0% $0 $0 0% $200,000 $0 -100% $7,000,000 $9,190,325 31% $0 $24,000,000 100% $19,000,000 $0 -100%
Texas $23,581,066 $24,201,455 3% $0 $0 0% $1,884,208 $0 -100% $0 $0 0% $68,823,596 $69,178,158 1% $0 $15,000,000 100% $0 $0 0% $0 $0 0% $300,800 $350,668 14% $15,182,521 $16,185,616 7% $30,504,191 $30,504,191 0% $0 $16,000,000 100% $0 $10,000,000 100%
Utah $1,515,696 $1,725,798 14% $204,445 $55,029 -73% $1,831,903 $852,788 -53% $167,772 $174,480 4% $2,260,932 $2,301,787 2% $167,772 $0 -100% $1,322,937 $1,322,937 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $1,780,964 $2,599,513 46% $3,500,000 $3,564,380 2%
Vermont $500,000 $500,000 0% $0 $0 0% $0 $329,891 100% $0 $0 0% $407,375 $403,601 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $522,000 $645,750 24% $750,000 $1,102,537 47%
Virgin Islands (U.S.) $342,500 $94,681 -72% $157,500 $247,488 57% $187,509 $0 -100% $463,329 $0 -100% $517,367 $368,506 -29% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $196,875 $62,000 -69% $0 $18,000 100% $171,460 $501,956 193% $0 $0 0%
Virginia $7,068,769 $6,965,287 -1% $0 $0 0% $0 $0 0% $0 $0 0% $18,646,378 $17,978,375 -4% $0 $0 0% $11,000,000 $0 -100% $0 $0 0% $0 $0 0% $103,371 $93,626 -9% $1,576,747 $237,812 -85% $23,532,989 $22,601,793 -4% $4,814,738 $13,539,755 181%
Washington $2,869,519 $3,351,493 17% $743,207 $286,059 -62% $0 $3,691,384 100% $0 $0 0% $10,180,306 $10,012,773 -2% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $1,547,218 $944,404 -39% $0 $0 0% $16,045,193 $0 -100% $23,282,382 $29,788,273 28%
West Virginia $1,008,638 $0 -100% $0 $1,005,628 100% $0 $2,623,704 100% $0 $0 0% $1,442,108 $1,407,086 -2% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $10,000 $0 -100% $0 $0 0% $1,864,875 $0 -100% $3,380,253 $1,183,672 -65%
Wisconsin $3,588,620 $3,616,794 1% $0 $0 0% $2,509,106 $2,041,035 -19% $0 $0 0% $4,741,847 $4,698,956 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $4,000,000 $4,000,040 0.001% $1,306,200 $1,306,200 0% $0 $2,722,886 100% $11,260,520 $16,457,304 46%
Wyoming $500,000 $500,000 0% $0 $0 0% $0 $0 0% $0 $0 0% $253,387 $249,886 -1% $0 $0 0% $0 $0 0% $0 $0 0% $0 $0 0% $70,000 $140,000 100% $250,000 $250,000 0% $0 $200,000 10% $400,000 $500,000 25%
Total $283,321,837 $254,049,591 -10% $30,933,828 $59,951,272 94% $74,006,055 $51,483,826 -30% $91,398,169 $38,134,531 -58% $820,593,854 $808,941,062 -1% $18,864,324 $37,572,304 99% $53,770,073 $51,210,229 -5% $0 $0 0% $15,336,237 $9,253,890 -40% $81,463,121 $105,526,352 30% $120,226,218 $124,129,672 3% $233,347,593 $308,951,250 32% $686,694,503 $874,075,643 27%

Table 5

Scroll or click the table to use your arrow keys

State/Territory Private Insurance Medicaid Other Total
Alabama $0 $0 $0 $0
Alaska $1,345,769 $0 $0 $1,345,769
American Samoa -- -- -- --
Arizona $25 $18 $2,390 $2,433
Arkansas $0 $8,960 $0 $8,960
California $0 $0 $0 $0
Colorado $0 $0 $0 $0
Connecticut $6,515 $0 $0 $6,515
Delaware $0 $0 $0 $0
District of Columbia $3,700 $0 $0 $3,700
Federated States of Micronesia -- -- -- --
Florida $416,174 $0 $0 $416,174
Georgia $2,113,788 $0 $0 $2,113,788
Guam -- -- -- --
Hawaii $0 $0 $0 $0
Idaho $0 $0 $0 $0
Illinois $18,980,420 $19,580 $0 $19,000,000
Indiana $0 $0 $0 $0
Iowa $34,072 $5,007 $0 $39,079
Kansas -- -- -- --
Kentucky $36,438 $0 $0 $36,438
Louisiana $17,162 $0 $49,008 $66,170
Maine $0 $340,020 $0 $340,020
Marshall Islands -- -- -- --
Maryland $121,825 $164,093 $0 $285,918
Massachusetts $0 $0 $0 $0
Michigan $0 $236,478 $0 $236,478
Minnesota $0 $0 $0 $0
Mississippi $0 $0 $0 $0
Missouri $720,814 $4,084,615 $0 $4,805,429
Montana $10,479 $0 $0 $10,479
Nebraska $0 $0 $0 $0
Nevada $0 $0 $0 $0
New Hampshire $0 $0 $0 $0
New Jersey $2,111,810 $4,697,763 $0 $6,809,573
New Mexico $1,813,955 $0 $0 $1,813,955
New York $0 $1,200,000 $0 $1,200,000
North Carolina $0 $0 $0 $0
North Dakota $0 $0 $0 $0
Northern Mariana Islands -- -- -- --
Ohio $0 $0 $0 $0
Oklahoma $0 $0 $0 $0
Oregon $43,000,000 $0 $0 $43,000,000
Pennsylvania $0 $0 $0 $0
Puerto Rico $0 $45,826,722 $0 $45,826,722
Republic of Palau -- -- -- --
Rhode Island $7,259,624 $0 $0 $7,259,624
South Carolina $0 $0 $1,556,336 $1,556,336
South Dakota $0 $0 $0 $0
Tennessee $0 $6,114 $0 $6,114
Texas $0 $0 $0 $0
Utah $2,625 $62,614 $0 $65,239
Vermont $0 $0 $0 $0
Virgin Islands (U.S.) $0 $60,000 $0 $60,000
Virginia $0 $87,149 $0 $87,149
Washington $0 $0 $0 $0
West Virginia $0 $0 $0 $0
Wisconsin $0 $0 $0 $0
Wyoming $0 $0 $0 $0
Totals $77,995,195 $56,799,133 $1,607,734 $136,402,062
Total # of ADAPs 18 15 3 27

Section Two

Effective and Comprehensive Care in Achieving an End to the HIV Epidemic (EHE)

Overview of Jurisdictional and Federal EHE Efforts

In February 2019, President Trump announced Ending the HIV Epidemic: A Plan for America (EHE), which is the Administration’s plan to end the HIV epidemic by 2030. The plan’s goals are to reduce new HIV infections by 75% by 2025 and by 90% by 2030. In Phase 1, EHE funding is initially focused on 48 counties with the highest burden, Washington DC, San Juan, Puerto Rico, and 7 states that have substantial rural burden. In the first year, the Administration requested funding for the Centers for Disease Control and Prevention (CDC), HRSA, the Indian Health Service (IHS), and the National Institutes of Health (NIH) in their budget. Congress provided FY2020 funding for EHE programming at CDC, HRSA’s HIV/AIDS Bureau and Primary Care Bureau, and the National Institutes of Health (NIH). EHE implementation will be focused on four pillars: (1) diagnose all PLWH as early as possible; (2) treat PLWH rapidly and effectively to reach sustained viral suppression; (3) prevent new HIV transmissions by using proven interventions, including pre-exposure prophylaxis (PrEP) and syringe services programs (SSPs); and (4) respond quickly to potential HIV outbreaks to get needed prevention and treatment services to the people who need them. In September 2019, EHE jurisdictions began to develop plans to end the HIV epidemic with implementation beginning in 2020.

  View Larger

Chart 3

Engagement in RWHAP Part B and ADAP, Calendar Year 2018

Engagement in RWHAP Part B and ADAP, Calendar Year 2018

  View Larger

Chart 4

RWHAP Part B Clients Served, by Viral Load, Calendar Year 2018

RWHAP Part B Clients Served, by Viral Load, Calendar Year 2018

RWHAP Part B programs and ADAPs are critical to jurisdictional and national EtE efforts at all levels, including the Administration’s EHE initiative, by providing broad and tailorable services to meet the needs of all PLWH and key populations. They are also integral to “undetectable = untransmittable (U=U)”, an evidenced-based campaign asserting that PLWH who are on antiretroviral therapy (ART) and durably virally suppressed (i.e., viral load < 200 copies/mL) do not sexually transmit HIV. As compared to the general population, Part B and ADAP clients demonstrate higher outcomes across the HIV care continuum. Part B client enrollment ranges from 164 (U.S. Virgin Islands) to 29,706 (Florida). While forty-percent of PLWH in the U.S. have been estimated to be retained in care (i.e., had two or more medical visits in a calendar year, three months or more apart); 64% of Part B and ADAP clients were reported as retained (i.e., were successfully recertified twice in a 12-month period of time). Seventy-one percent of Part B clients, regardless of whether they are on ARV treatment, were reported as being virally suppressed based on their most recent viral load recorded as of December 31, 2018. This is significantly more than the estimated 51% of all PLWH who are virally suppressed. By comparison, 69% and 61% of clients served in CY2016 and CY2017, respectively, were reported as virally suppressed, demonstrating an upward trajectory overall. RWHAP Part B programs with the highest rates of viral load suppression in CY2018 include Wyoming (96%), Arizona (94%), Rhode Island (94%), New York (92%), Maine (91%), Ohio (90%), South Carolina (90%), and Vermont (90%). These programs vary considerably in geographic region and client enrollment/utilization (Wyoming, 225 and New York, 20,133). Furthermore, seven (Arizona, Maine, New York, Ohio, Rhode Island, South Carolina, Vermont, and Wyoming) have reported having either maintained or increased the proportion of virally suppressed clients since CY2017.

ADAPs, as providers of life-saving treatments necessary to achieving viral load suppression, including ARVs and treatments for comorbid conditions that might affect adherence to or the effectiveness of ARV treatment, demonstrate even higher rates of viral load suppression among their clients served (80%). While ARVs represent 95% of all CY2018 ADAP drug expenditures, 0.4% and 1% were expended on hepatitis B and C treatment, respectively. All other medications comprised 0.2% of drug expenditures. Viral load suppression is highest among those clients served by ADAP-funded insurance alone (94%) and in combination with the full-pay prescription program (83%). Eighteen ADAPs reported viral load suppression rates of 90% or greater; 16 reported rates of 80-90%; ten reported rates of 70-80%; and nine reported rates of less than 70%. The ADAPs with the highest rates of viral load suppression include Arizona (99%), Massachusetts (94%), Oregon (94%), Vermont (94%), Michigan (93%), New York (93%), and Wyoming (93%). Nineteen percent of ADAP clients served in 2014 were reported as virally suppressed, the earliest year in which these data were available. This significant change over time is a testament to the increasing effectiveness of ADAPs in reporting and ensuring optimal health outcomes among their clients served.

Together, RWHAP Part B programs and ADAPs, including those to be funded in the first five years of the EHE, can make meaningful contributions toward widespread viral load suppression.

  View Larger

Chart 5

ADAP Clients Served by Program, by Viral Load, Calendar Year 2018

ADAP Clients Served by Program, by Viral Load, Calendar Year 2018

Table 6

Scroll or click the table to use your arrow keys

State/Territory County Targeted FOA HRSA-20-078 RWHAP Eligibility State/Territory, Percent Diagnosed, 2016* State/Territory, Diagnosed Prevalence, 2016** Diagnosed Prevalence, County Percentage of State/Territory Total, 2016 Part B and ADAP Clients Enrolled and Served, 2018 State/Territory, Estimated Annual Incidence, 2016* State/Territory, Annual HIV Diagnoses, 2017** Annual HIV Diagnoses, County Percentage of State/Territory Total, 2017 Medicaid Expanison Status*** State/Territory, Percent Virally Suppressed among Diagnosed, 2016**** All Part B Clients Services, Percent Virally Suppressed, 2018 All ADAP Clients Served, Percent Virally Suppressed, 2018 State/Territory Ending the HIV Epidemic Plans
Alabama State rural burden Part B 84% 12643 7039 620 653 Not adopted 61% 57% 80%
Arizona Maricopa Part A (Phoenix EMA) 84% 15676 69% 2915 790 764 68% Adopted and implemented N/A 94% 99% https://hivaz.org/victory
Arkansas State rural burden Part B 85% 5516 2300 N/A 290 Adopted and implemented N/A 70% 73%
California Alameda, Los Angeles, Orange, Riverside, Sacremento, San Bernardino, San Diego, San Francisco Part A (Oakland TGA, Los Angeles EMA, Orange County TGA, Riverside-San Barnardino TGA, Sacremento TGS, San Diego TGA, San Francisco EMA) 86% 126129 88% 17948 5300 4495 74% Adopted and implemented 66% 57% 86% State: https://www.cdph.ca.gov/Programs/CID/DOA/CDPH%20Document%20Library/IP_2016_Final.pdf; Los Angeles: https://www.lacounty.hiv/; Sacramento: https://www.nastad.org/sites/default/files/zero-together-plan-rcvd-12.20.16.pdf; San Diego: http://www.sdplanning.org/download/getting-to-zero-integrated-plan-for-2017-2021/?wpdmdl=3206; San Francisco: https://www.gettingtozerosf.org/getting-to-zero-july-2015-strategic-plan/
District of Columbia State rural burden Part A (Washington EMA) 86% 14495 6718 420 319 Adopted and implemented 55% 47% 77%
Florida Broward, Duval, Hillsborough, Miami-Dade, Orange, Palm Beach, Pinellas Part A (Fort Lauderdale EMA, Jacksonville TGA, Tampa-St. Petersburg EMA, Miami EMA, Orlando, EMA, West Palm Beach EMA) 85% 108003 72% 29706 5000 4783 74% Not adopted 62% 50% 90% Miami: http://getting2zeromiami.com/
Georgia Cobb, Dekalb, Fulton, Gwinnett Part A (Atlanta EMA) 83% 51350 51% 10413 2500 2588 49% Not adopted 57% 77% 65%
Illiniois Cook Part A (Chicago EMA) 86% 35728 72% 11577 1400 1255 72% Adopted and implemented 54% 88% 91% State: https://gtzillinois.hiv/
Indiana Marion Part A (Indianaopolis TGA) 83% 10997 41% 3539 470 517 44% Adopted and implemented 62% 55% 70%
Kentucky State rural burden Part B 84% 6836 4692 N/A 349 Adopted and implemented N/A 81% 74%
Louisiana East Baton Rouge Parish, Orleans Parish Part A (Baton Rouge EMA, New Orleans EMA) 82% 20085 43% 5913 990 1031 35% Adopted and implemented 63% 84% 91%
Maryland Baltimore City, Montgomery, Prince George's Part A (Balitmore EMA, Washington EMA) 86% 32506 66% 10880 1200 1026 65% Adopted and implemented 55% 80% 92%
Massachusetts Suffolk Part A (Boston EMA) 86% 20060 29% 5007 670 605 27% Adopted and implemented 68% 62% 94% State: http://www.gettingtozeroma.org/wp-content/uploads/2017/06/GtZ-Blueprint_v1-2.pdf
Michigan Wayne Part A (Detroit EMA) 82% 15422 43% 3767 N/A 777 Adopted and implemented 71% 89% 93%
Mississippi State rural burden Part B 87% 9458 2688 250 428 Not adopted 53% 64% N/A
Missouri State rural burden Part B 87% 12104 7541 450 504 Not adopted 62% 87% 89%
Nevada Clark Part A (Las Vegas EMA) 82% 9194 84% 4051 520 494 90% Adopted and implemented N/A 80% 92%
New Jersey Essex, Hudson Part A (Newark EMA, Jersey City TGA) 90% 35452 40% 7793 1000 1108 41% Adopted and implemented N/A 47% 66%
New York Bronx, King, New York, Queens Part A (New York EMA) 89% 127934 76% 20133 3100 2768 71% Adopted and implemented 63% 92% 93% State: https://www.health.ny.gov/diseases/aids/ending_the_epidemic/docs/blueprint.pdf
North Carolina Mecklenburg Part A (Charlotte-Gastonia TGA) 85% 30310 18% 10613 1400 1311 21% Not adopted 62% 71% 86%
Ohio Cuyahoga, Franklin, Hamilton Part A (Celeveland-Lorain-Elyria TGA, Columbus TGA); Part B (for Hamilton County) 86% 21258 56% 5575 850 1020 57% Adopted and implemented 52% 90% 91%
Oklahoma State rural burden Part B 84% 5926 N/A 250 302 Not adopted 59% N/A 82%
Pennsylavania Philadelphia Part A (Philadelphia EMA) 92% 36159 49% 14367 850 1093 46% Adopted and implemented N/A 59% 57%
Puerto Rico San Juan Municipio Part A (San Juan EMA) N/A N/A N/A 6763 N/A 445 23% N./A 80% 81%
South Carolina State rural burden Part B 84% 16718 10388 670 714 Not adopted 62% 90% 75%
Tennessee Shelby Part A (Memphis TGA) 85% 16190 37% 8886 690 688 35% Not adopted 55% 53% 53%
Texas Bexar, Dallas, Harris, Tarrant, Travis Part A (San Antonio TGA, Dallas EMA, Houston EMA, Forth Worth TGA, Austin TGA) 82% 84802 67% 23036 4300 4358 64% Not adopted 61% 73% 59% State: https://achievingtogethertx.org/; Bexar: https://www.sanantonio.gov/Portals/0/Files/health/News/Reports/Fast-TrackCitiesSAReporttoCommunity.pdf?ver=2017-12-07-090036-390; Harris: https://endhivhouston.org/
Washington King Part A (Seattle TGA) 86% 12279 55% 5868 380 439 50% Adopted and implemented 77% 87% 90% https://www.doh.wa.gov/Portals/1/Documents/pubs/410-069-EndAIDSWashington2016Recommendations.pdf

Who are RWHAP Part B Program Clients?

In calendar year 2018 (CY2018), 283,480 clients were served by RWHAP Part B core medical and support services, representing 26% of the 1.1 million people estimated to be living with HIV in the United States. This represents a 16% increase from the 245,245 reported as served in CY2017. Within ADAP, 242,727 clients were reported as served in CY2018, with 54% by ADAP-funded insurance (i.e., the client had either public or private insurance for which the ADAP paid premium(s), deductible payment(s) and/or cost-sharing/co-payments) and 46% by the full-pay prescription program only. As RWHAP Part B programs/ADAPs served over half of all RWHAP clients and one-fourth of all PLWH nationally, they are a critical component to the public health and health care infrastructures necessary to reaching an end to the HIV epidemic.

To fulfill their mission and purpose in achieving optimal health outcomes among the PLWH served by their programs, RWHAP Part B programs and ADAPs must develop and maintain systems that are responsive to the challenges faced by their clients. As stipulated by the Ryan White CARE Act, individuals served by RWHAP Part B programs are low-income and under/uninsured. Among RWHAP Part B clients served during calendar year 2018, 49% had incomes less than 100% of the federal poverty level (FPL) whereas 12% of the general population were living at or below the FPL. By comparison, 53% of RWHAP Part B clients were reported as having incomes below 100% FPL in calendar year 2017. RWHAP Part B clients were also more likely to be people of color (57% vs. 23%), with the majority 82% of clients of color reported as Black/African American. By ethnicity, 21% of RWHAP Part B clients were reported as Hispanic/Latinx (vs. 18% in the general population). The majority of clients served identified as male (72%) whereas 26% were identified as female. Comparatively, 49% and 51% of the U.S. population in 2018 were reported as male and female, respectively. This difference is reflective of the disproportionate prevalence of HIV among men nationally; 76% of all adult PLWH in 2017 were male. One percent of RWHAP Part B clients were reported as transgender in CY2018, 86% of whom identified as trans women, 3% as trans men, and 10% as transgender - other.

There are key differences in the clients served by RWHAP Part B core medical/support services vs. those served by ADAP specifically. RWHAP Part B programs, outside of ADAP, may provide more services to low-income PLWH that are not otherwise covered by Medicaid or other payers. Forty percent of ADAP clients served in CY2018 had incomes below 100% FPL, 13% less than those served by RWHAP Part B (53%). In 2017, 40% of all RWHAP clients were enrolled in Medicaid. Forty-four percent of ADAP clients were reported as people of color – slightly less than the 57% of RWHAP Part B clients. A greater proportion of ADAP clients (89%) were Black/African American, compared to 82% of RWHAP Part B clients. Twenty-seven percent were of Hispanic/Latinx ethnicity (vs. 21% among RWHAP Part B clients). By gender, ADAP clients were more likely to be male than those PLWH served by RWHAP Part B; 77% of ADAP clients were reported as male, 21% as female, and 1% as transgender. Among transgender ADAP clients, 84% were reported as trans women, 3% as trans men, and 13% as transgender – other.

RWHAP Part B programs and ADAPs are well-positioned to address the complex needs of these clients through their expansive and flexible service delivery and the opportunities that an evolving healthcare system has afforded them in bolstering it.

  View Larger

Chart 6

RWHAP Part B Clients Served and Top Ten States, by Clients Served, Calendar Year 2018

RWHAP Part B Clients Served and Top Ten States, by Clients Served, Calendar Year 2018

  View Larger

Chart 7

ADAP Clients Served and Top Ten States, by Clients Served, Calendar Year 2018

ADAP Clients Served and Top Ten States, by Clients Served, Calendar Year 2018

  View Larger

Chart 8

ADAP Clients Served, by Program Type, Calendar Year 2018

ADAP Clients Served, by Program Type, Calendar Year 2018

  View Larger

Chart 9

RWHAP Part B Program Viral Load Suppression Rate, by Clients Served, Calendar Year 2018

RWHAP Part B Program Viral Load Suppression Rate, by Clients Served, Calendar Year 2018

  View Larger

Chart 10

ADAP Viral Load Suppression Rate, by Clients Served, Calendar Year 2018

ADAP Viral Load Suppression Rate, by Clients Served, Calendar Year 2018

  View Larger

Chart 11

RWHAP Part B Clients Served, by Demographic, Calendar Year 2018

RWHAP Part B Clients Served, by Demographic, Calendar Year 2018

  View Larger

Chart 12

ADAP Clients Served, by Demographic, Calendar Year 2018

ADAP Clients Served, by Demographic, Calendar Year 2018

Table 7

Scroll or click the table to use your arrow keys

State/Territory Ryan White Part B ADAP Only
Calendar Year 2018 Clients Enrolled Calendar Year 2018 New Clients Enrolled Calendar Year 2018 Clients Enrolled and Recertified Twice in 12-Month Period Calendar Year 2018 Clients Served Calendar Year 2018 Clients Enrolled Calendar Year 2018 New Clients Enrolled Calendar Year 2018 Clients Enrolled and Recertified Twice in 12-Month Period Calendar Year 2018 Clients Served 1
Full-Pay Medications Only ADAP-Funded Insurance Only2 Full-Pay Medications and ADAP-Funded Insurance3 Total Clients Served
Alabama 7,039 -- -- 7,039 3,865 660 3,002 1,116 2,226 523 3,865
Alaska 243 20 243 243 78 13 78 19 59 0 78
American Samoa -- -- -- -- -- -- -- -- -- -- --
Arizona 2,979 441 2,128 2,915 2,929 47 2,519 903 1,650 229 2,782
Arkansas 2,396 328 1,126 2,300 1,920 515 1,137 655 709 370 1,734
California 17,948 1,541 -- 17,948 35,266 4,719 21,237 11,735 15,855 2,489 30,079
Colorado 2,236 -- -- 2,236 5,515 1,380 4,825 540 4,319 656 5,515
Connecticut 2,425 318 2,147 2,425 1,624 334 1,347 1,012 111 501 1,624
Delaware 1,613 154 1,289 1,532 1,893 154 1,401 59 1,301 0 1,360
District of Columbia 6,718 827 719 6,718 1,309 124 768 542 279 0 821
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- --
Florida 34,912 7,872 5,428 29,706 27,375 4,325 13,756 15,077 6,602 2,085 23,764
Georgia 13,329 2,182 8,057 10,413 12,747 2,572 7,929 10,773 1,406 0 12,179
Guam -- -- -- -- -- -- -- -- -- -- --
Hawaii 917 265 -- 917 481 105 365 81 318 44 443
Idaho 268 34 140 268 353 115 127 348 0 0 348
Illinois 13,734 2,128 8,254 11,577 13,302 2,059 7,952 3,912 2,715 2,315 8,942
Indiana 4,289 1,331 2,206 3,539 3,509 571 1,986 1,167 1,433 179 2,779
Iowa 2,021 389 -- 2,021 776 231 737 76 422 236 734
Kansas 1,585 139 1,241 1,300 1,580 155 1,142 125 1,315 2 1,442
Kentucky 4,810 628 3,543 4,692 4,810 502 3,538 601 2,390 961 3,952
Louisiana 6,627 869 4,944 5,913 4,684 578 3,667 270 3,288 178 3,736
Maine 1,087 116 892 771 1,087 116 892 45 585 73 703
Marshall Islands -- -- -- -- -- -- -- -- -- -- --
Maryland 10,880 2,875 7,224 10,880 7,149 831 3,998 1,034 3,629 1,173 5,836
Massachusetts 5,007 464 -- 5,007 7,904 637 2,473 199 5,199 208 5,606
Michigan 4,498 792 2,268 3,767 3,550 315 2,852 637 2,264 386 3,287
Minnesota 2,886 411 -- 2,886 2,167 294 -- 292 849 443 1,584
Mississippi 2,688 560 2,263 2,688 2,764 554 2,263 2,726 32 0 2,758
Missouri 7,811 710 5,575 7,541 5,699 609 3,935 1,227 2,407 603 4,237
Montana 353 83 261 351 268 49 217 75 181 4 260
Nebraska 494 57 397 494 943 139 658 235 708 0 943
Nevada 4,051 1,522 1,731 4,051 2,639 852 1,763 919 1,532 188 2,639
New Hampshire 645 74 517 529 645 74 517 89 129 275 493
New Jersey 7,793 1,151 -- 7,793 6,720 797 5,503 3,207 2,579 0 5,786
New Mexico 1,356 197 964 659 541 116 395 12 400 53 465
New York 21,457 2,565 21,214 20,133 23,899 2,775 23,643 8,011 3,877 9,253 21,141
North Carolina 10,613 1,721 10,613 10,613 10,825 1,469 7,006 7,287 1,940 295 9,522
North Dakota 320 54 243 317 320 54 243 53 150 33 236
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- --
Ohio 7,265 1,275 4,228 5,575 6,508 1,017 3,977 1,184 2,185 791 4,160
Oklahoma -- -- -- -- 2,254 338 1,409 457 1,309 345 2,111
Oregon 1,511 196 725 1,336 4,001 432 3,357 150 1,980 1,136 3,266
Pennsylvania 14,367 -- -- 14,367 8,483 1,167 4,952 5,176 11 2,959 8,146
Puerto Rico 6,763 582 4,734 6,763 8,041 740 6,985 7,495 71 237 7,803
Republic of Palau -- -- -- -- -- -- -- -- -- -- --
Rhode Island 752 187 752 752 718 76 570 512 206 0 718
South Carolina 10,388 973 9,349 10,388 6,007 879 3,208 2,426 2,516 625 5,567
South Dakota 390 79 249 387 390 79 249 39 222 59 320
Tennessee 9,896 1,255 3,920 8,886 8,681 986 3,535 1,743 4,413 1,515 7,671
Texas 23,036 2,579 20,457 23,036 21,941 1,323 9,520 13,747 2,201 190 16,138
Utah 1,365 228 727 1,174 935 153 487 291 408 114 813
Vermont 467 32 467 467 448 38 389 10 438 0 448
Virgin Islands (U.S.) 165 7 163 164 144 4 144 79 45 2 126
Virginia 6,231 1,552 4,206 5,717 8,093 1,286 2,328 2,135 3,997 1,132 7,264
Washington 5,868 745 5,488 5,868 4,492 810 3,946 245 3,267 516 4,028
West Virginia 1,321 127 1,212 1,281 522 67 508 142 331 49 522
Wisconsin 4,912 -- -- 4,912 1,953 262 1,410 766 289 728 1,783
Wyoming 225 29 173 225 226 29 170 24 126 20 170
Total 302,950 42,664 152,477 283,480 284,973 38,526 181,015 111,680 96,874 34,173 242,727

Table 8

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2018 Ryan White Part B Clients Served, Including ADAP All Ryan White Part B Clients Served Calendar Year 2018 ADAP Clients Served Only All ADAP Clients Served Subset of Calendar Year 2018 Clients Served by Full-Pay Medications Full-Pay Medications Subset of Calendar Year 2018 Clients Served by ADAP-Funded Insurance 2 ADAP-Funded Insurance Only 2 Subset of Calendar Year 2018 Clients Served by Full-Pay Medications and ADAP-Funded Insurance 3 Full-Pay Medications and ADAP-Funded Insurance 3
Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown Viral Load ≤200 Viral Load >200 Unknown
Alabama 7,039 57% 10% 33% 3,865 80% 13% 7% 1,116 -- -- -- 2,226 -- -- -- 523 -- -- --
Alaska 243 0% 0% 100% 78 0% 0% 100% 19 -- -- -- 59 -- -- -- 0 -- -- --
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 2,915 94% 2% 4% 2,782 99% 1% 1% 903 98% 1% 0.4% 1,650 99% 0.5% 1% 229 99% 1% 0%
Arkansas 2,300 70% 15% 15% 1,734 73% 11% 16% 655 -- -- -- 709 -- -- -- 370 -- -- --
California 17,948 57% 9% 34% 30,079 86% 6% 7% 11,735 -- -- -- 15,855 -- -- -- 2,489 -- -- --
Colorado 2,236 0% 0% 100% 5,515 72% 10% 18% 540 -- -- -- 4,319 -- -- -- 656 -- -- --
Connecticut 2,425 82% 8% 10% 1,624 68% 7% 25% 1,012 71% 8% 21% 111 0% 0% 100% 501 78% 6% 16%
Delaware 1,532 78% 22% 0% 1,360 83% 18% 0% 59 -- -- -- 1,301 -- -- -- 0 -- -- --
District of Columbia 6,718 47% 53% 0% 821 77% 10% 14% 542 -- -- -- 279 -- -- -- 0 -- -- --
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 29,706 50% 8% 42% 23,764 90% 10% 0.004% 15,077 86% 14% 0% 6,602 96% 4% 0.02% 2,085 95% 5% 0%
Georgia 10,413 77% 14% 10% 12,179 65% 15% 20% 10,773 62% 16% 22% 1,406 91% 8% 1% 0 0% 0% 0%
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 917 82% 9% 9% 443 90% 6% 4% 81 -- -- -- 318 -- -- -- 44 -- -- --
Idaho 268 80% 5% 15% 348 84% 4% 12% 348 84% 4% 12% 0 0% 0% 0% 0 0% 0% 0%
Illinois 11,577 88% 11% 0% 8,942 91% 9% 0.1% 3,912 86% 13% 0% 2,715 94% 6% 0% 2,315 94% 6% 0%
Indiana 3,539 55% 8% 37% 2,779 70% 10% 20% 1,167 69% 13% 18% 1,433 71% 8% 22% 179 74% 12% 15%
Iowa 2,021 86% 8% 7% 734 92% 4% 4% 76 82% 12% 7% 422 93% 3% 4% 236 93% 5% 2%
Kansas 1,300 88% 12% 0% 1,442 88% 12% 0% 125 -- -- -- 1,315 -- -- -- 2 -- -- --
Kentucky 4,692 81% 9% 11% 3,952 74% 22% 4% 601 -- -- -- 2,390 -- -- -- 961 -- -- --
Louisiana 5,913 84% 10% 6% 3,736 91% 6% 3% 270 81% 13% 6% 3,288 92% 5% 3% 178 88% 10% 3%
Maine 771 91% 6% 3% 703 93% 5% 3% 45 80% 9% 11% 585 93% 5% 2% 73 99% 1% 0%
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 10,880 80% 11% 9% 5,836 92% 8% 0.1% 1,034 86% 13% 0.3% 3,629 94% 6% 0% 1,173 92% 8% 0%
Massachusetts 5,007 62% 6% 32% 5,606 94% 6% 0.2% 199 76% 23% 1% 5,199 94% 5% 0.2% 208 91% 9% 0.5%
Michigan 3,767 89% 9% 2% 3,287 93% 6% 1% 637 84% 14% 2% 2,264 95% 4% 1% 386 94% 5% 1%
Minnesota 2,886 74% 9% 18% 1,584 88% 6% 6% 292 -- -- -- 849 -- -- -- 443 -- -- --
Mississippi 2,688 64% 21% 15% 2,758 0% 0% 100% 2,726 -- -- -- 32 -- -- -- 0 -- -- --
Missouri 7,541 87% 13% 0% 4,237 89% 11% 0% 1,227 83% 17% 0% 2,407 92% 8% 0% 603 88% 12% 0%
Montana 351 89% 7% 3% 260 92% 8% 0% 75 -- -- -- 181 -- -- -- 4 -- -- --
Nebraska 494 89% 11% 0% 943 71% 6% 23% 235 -- -- -- 708 -- -- -- 0 -- -- --
Nevada 4,051 80% 13% 7% 2,639 92% 8% 1% 919 -- -- -- 1,532 -- -- -- 188 -- -- --
New Hampshire 529 89% 6% 5% 493 87% 6% 7% 89 -- -- -- 129 -- -- -- 275 -- -- --
New Jersey 7,793 47% 11% 42% 5,786 66% 7% 26% 3,207 -- -- -- 2,579 -- -- -- 0 -- -- --
New Mexico 659 82% 18% 0% 465 91% 9% 0% 12 -- -- -- 400 -- -- -- 53 -- -- --
New York 20,133 92% 4% 4% 21,141 93% 3% 4% 8,011 -- -- -- 3,877 -- -- -- 9,253 -- -- --
North Carolina 10,613 71% 10% 19% 9,522 86% 9% 5% 7,287 85% 9% 6% 1,940 88% 10% 2% 295 91% 7% 2%
North Dakota 317 80% 8% 12% 236 89% 6% 5% 53 85% 11% 4% 150 91% 5% 5% 33 88% 6% 6%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 5,575 90% 10% 0% 4,160 91% 9% 0.4% 1,184 84% 16% 1% 2,185 95% 5% 0.1% 791 91% 9% 0.3%
Oklahoma -- -- -- -- 2,111 82% 14% 4% 457 -- -- -- 1,309 -- -- -- 345 -- -- --
Oregon 1,336 82% 8% 10% 3,266 94% 6% 0% 150 83% 17% 0% 1,980 94% 6% 0% 1,136 96% 4% 0%
Pennsylvania 14,367 59% 7% 33% 8,146 57% 7% 36% 5,176 57% 8% 34% 11 55% 0% 45% 2,959 57% 5% 38%
Puerto Rico 6,763 80% 8% 12% 7,803 81% 12% 7% 7,495 81% 13% 7% 71 82% 10% 8% 237 91% 5% 3%
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island 752 94% 6% 0% 718 58% 8% 35% 512 -- -- -- 206 -- -- -- 0 -- -- --
South Carolina 10,388 90% 10% 0% 5,567 75% 15% 11% 2,426 72% 23% 5% 2,516 77% 8% 15% 625 77% 12% 11%
South Dakota 387 85% 13% 2% 320 87% 13% 0% 39 67% 33% 0% 222 90% 10% 0% 59 88% 12% 0%
Tennessee 8,886 53% 14% 32% 7,671 53% 14% 32% 1,743 51% 23% 26% 4,413 55% 13% 32% 1,515 51% 8% 41%
Texas 23,036 73% 21% 5% 16,138 59% 11% 31% 13,747 -- -- -- 2,201 -- -- -- 190 -- -- --
Utah 1,174 82% 10% 8% 813 85% 9% 6% 291 78% 16% 6% 408 88% 5% 6% 114 89% 5% 5%
Vermont 467 90% 5% 5% 448 94% 6% 0% 10 -- -- -- 438 -- -- -- 0 -- -- --
Virgin Islands (U.S.) 164 80% 17% 3% 126 71% 9% 20% 79 -- -- -- 45 -- -- -- 2 -- -- --
Virginia 5,717 75% 19% 6% 7,264 72% 18% 9% 2,135 57% 35% 8% 3,997 78% 11% 11% 1,132 79% 13% 8%
Washington 5,868 87% 9% 4% 4,028 73% 7% 20% 245 -- -- -- 3,267 -- -- -- 516 -- -- --
West Virginia 1,281 87% 11% 2% 522 87% 13% 0.2% 142 -- -- -- 331 -- -- -- 49 -- -- --
Wisconsin 4,912 64% 7% 29% 1,783 88% 4% 6% 766 86% 9% 5% 289 90% 3% 6% 728 89% 5% 6%
Wyoming 225 96% 4% 0% 170 93% 5% 2% 24 88% 13% 0% 126 93% 5% 2% 20 100% 0% 0%
Total 283,480 71% 11% 18% 242,727 80% 9% 11% 111,680 76% 14% 10% 96,874 88% 7% 6% 34,173 81% 7% 12%

Table 9

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2017 Part B Clients Served Black / African American White Asian Native Hawaiian / Pacific Islander American Indian / Alaskan Native Multi-Racial Other Unknown Calendar Year 2017 ADAP Clients Served Black/African American White Asian Native Hawaiian / Pacific Islander American Indian / Alaskan Native Multi-Racial Other Unknown
Alabama 7,039 73% 25% 1% 0.2% 0.4% 0% 0% 1% 3,865 65% 28% 0.1% 0% 0% 6% 0% 0%
Alaska 243 0% 0% 0% 0% 0% 0% 0% 100% 78 19% 71% 8% 0% 3% 0% 0% 0%
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 2,915 11% 74% 1% 0.1% 5% 7% 0% 1% 2,782 13% 79% 2% 0.04% 1% 5% 0% 0%
Arkansas 2,300 44% 46% 0.4% 0.1% 0.3% 8% 0% 1% 1,734 45% 49% 1% 0.2% 0.3% 4% 0.2% 0%
California 17,948 15% 32% 3% 1% 1% 1% 44% 3% 30,079 12% 74% 4% 0.4% 0.4% 1% 0% 7%
Colorado 2,236 4% 29% 1% 0% 1% 0% 1% 64% 5,515 20% 72% 3% 1% 5% 0% 0% 0%
Connecticut 2,425 45% 50% 0.4% 0.1% 0.3% 3% 0.4% 0% 1,624 37% 58% 1% 0.2% 1% 0% 0% 2%
Delaware 1,532 63% 35% 0.1% 0.1% 0.1% 1% 0% 0% 1,360 64% 35% 0.1% 0.1% 0.1% 1% 0% 0%
District of Columbia 6,718 82% 13% 1% 0.2% 1% 0% 0% 4% 821 66% 33% 0.5% 0% 0.2% 0% 0% 0%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 29,706 47% 50% 1% 0.1% 0.1% 1% 0.03% 1% 23,764 43% 55% 1% 0.1% 0.1% 1% 1% 0.3%
Georgia 10,413 70% 26% 0.5% 0.01% 0.1% 3% 0.2% 0.3% 12,179 73% 25% 1% 0.1% 0.1% 0.3% 1% 0.3%
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 917 5% 62% 14% 15% 3% 0% 0.3% 1% 443 4% 52% 18% 10% 1% 8% 0% 7%
Idaho 268 7% 87% 0.4% 0.4% 2% 3% 0% 0% 348 11% 84% 1% 0% 1% 3% 0% 0%
Illinois 11,577 47% 48% 2% 0.1% 1% 1% 2% 0.2% 8,942 43% 51% 2% 0.1% 1% 1% 2% 0.1%
Indiana 3,539 39% 48% 3% 0.2% 0.3% 0% 0% 10% 2,779 38% 48% 3% 0.1% 0.3% 0.1% 0% 11%
Iowa 2,021 28% 67% 3% 0.1% 1% 2% 0.05% 0% 734 24% 70% 3% 0.3% 0.4% 2% 0% 0%
Kansas 1,300 28% 69% 1% 0.3% 1% 0% 0% 0% 1,442 29% 67% 2% 0.2% 1% 0% 0% 0%
Kentucky 4,692 34% 64% 1% 0.2% 1% 0% 0% 0% 3,952 35% 62% 1% 0.2% 1% 0% 0% 0%
Louisiana 5,913 64% 32% 0.4% 0.2% 0.2% 1% 3% 0% 3,736 60% 35% 1% 0.2% 0.4% 0.3% 3% 0%
Maine 771 24% 70% 0.3% 0% 1% 5% 0% 0% 703 24% 71% 1% 0% 1% 3% 0% 0%
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 10,880 76% 16% 1% 0.1% 0.1% 5% 1% 2% 5,836 71% 20% 1% 0.1% 0.3% 1% 3% 4%
Massachusetts 5,007 39% 47% 1% 0.2% 0.3% 2% 0% 9% 5,606 30% 53% 2% 0.2% 0.2% 1% 0% 13%
Michigan 3,767 42% 50% 2% 0.2% 1% 4% 0.3% 1% 3,287 46% 48% 2% 0.1% 0.5% 3% 0.2% 0.1%
Minnesota 2,886 44% 39% 1% 0.1% 2% 3% 10% 0.3% 1,584 34% 49% 2% 0.2% 1% 2% 12% 0%
Mississippi 2,688 79% 19% 0.3% 0% 0% 1% 0% 0.3% 2,758 0% 0% 0% 0% 0% 0% 0% 100%
Missouri 7,541 52% 46% 1% 0.2% 1% 0% 0% 0% 4,237 52% 46% 1% 0.2% 1% 0% 0% 0%
Montana 351 3% 87% 1% 0.3% 9% 0% 0% 0% 260 3% 92% 1% 0% 4% 0% 0% 0%
Nebraska 494 29% 59% 1% 0.4% 2% 1% 7% 0% 943 26% 58% 3% 0% 1% 0% 0% 11%
Nevada 4,051 27% 66% 3% 1% 1% 2% 0% 1% 2,639 23% 70% 5% 1% 1% 0% 0% 0%
New Hampshire 529 17% 76% 1% 0.4% 0.4% 5% 0.2% 0% 493 17% 74% 1% 0.2% 0.4% 4% 0.2% 3%
New Jersey 7,793 57% 37% 1% 0.2% 0.1% 2% 0% 3% 5,786 31% 43% 2% 0.2% 0.1% 0% 1% 23%
New Mexico 659 5% 83% 0.3% 0.2% 5% 7% 0% 0% 465 4% 88% 1% 0.2% 2% 5% 0% 0.4%
New York 20,133 42% 40% 3% 0.3% 1% 5% 0.1% 10% 21,141 42% 40% 3% 0.2% 1% 5% 0.1% 10%
North Carolina 10,613 67% 29% 0.5% 0.1% 1% 1% 0.2% 2% 9,522 64% 30% 1% 1% 0.1% 2% 2% 0%
North Dakota 317 50% 41% 2% 0.3% 6% 0% 0% 0% 236 55% 39% 2% 0.4% 4% 0% 0% 0%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 5,575 45% 52% 1% 0.1% 0.3% 2% 0% 0% 4,160 42% 55% 1% 0.05% 0.3% 2% 0% 0%
Oklahoma -- -- -- -- -- -- -- -- -- 2,111 23% 61% 2% 0.1% 5% 9% 0% 0.3%
Oregon 1,336 4% 86% 1% 1% 2% 6% 0% 0.1% 3,266 7% 77% 2% 1% 1% 4% 5% 3%
Pennsylvania 14,367 49% 37% 1% 0.2% 0.2% 6% 1% 6% 8,146 47% 43% 1% 0.2% 0.5% 0% 0% 7%
Puerto Rico 6,763 13% 82% 0.04% 0% 0% 4% 0% 1% 7,803 0.2% 100% 0.01% 0.01% 0% 0.03% 0% 0.1%
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island 752 43% 49% 1% 0.3% 1% 2% 0% 4% 718 26% 57% 2% 0.4% 1% 8% 5% 1%
South Carolina 10,388 73% 25% 0.3% 0.04% 0.2% 1% 0% 0.2% 5,567 70% 28% 0.5% 0.1% 0.2% 1% 0.04% 0%
South Dakota 387 23% 47% 0% 0% 14% 16% 0.3% 0% 320 23% 51% 0% 0% 12% 14% 0.3% 0%
Tennessee 8,886 59% 40% 1% 0.1% 0.3% 0% 0% 0% 7,671 57% 42% 1% 0.1% 0.4% 0% 0% 0%
Texas 23,036 37% 23% 1% 0.1% 0.3% 1% 37% 0.1% 16,138 39% 59% 2% 0.1% 0.4% 0% 0% 0%
Utah 1,174 12% 82% 3% 0.4% 2% 0% 0% 0.4% 813 10% 84% 4% 0.4% 2% 0% 0% 0.4%
Vermont 467 11% 86% 2% 0.2% 1% 0% 0% 0% 448 9% 82% 2% 0.2% 5% 0% 0% 1%
Virgin Islands (U.S.) 164 87% 13% 0% 0% 0% 0% 0% 0% 126 92% 8% 0% 0% 0% 0% 0% 0%
Virginia 5,717 58% 39% 2% 0.1% 0.3% 1% 0% 0.2% 7,264 59% 32% 2% 0.01% 0.1% 7% 0% 0.1%
Washington 5,868 22% 66% 4% 1% 3% 5% 0.03% 1% 4,028 20% 72% 4% 1% 1% 2% 0.02% 0%
West Virginia 1,281 23% 75% 0.4% 0% 0.5% 1% 0% 0% 522 16% 83% 0.4% 0% 1% 0% 0% 0%
Wisconsin 4,912 43% 50% 2% 0.2% 1% 1% 0% 3% 1,783 35% 60% 2% 0.2% 1% 1% 0% 0.1%
Wyoming 225 8% 87% 0.4% 0.4% 4% 0% 0% 0% 170 8% 89% 1% 0% 3% 0% 0% 0%
Total 283,480 46% 40% 1% 0.2% 1% 2% 6% 3% 242,727 39% 52% 2% 0.2% 1% 2% 1% 4%

Table 10

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2018 Part B Clients Served Hispanic Non-Hispanic Unknown Calendar Year 2018 ADAP Clients Served Hispanic Non-Hispanic Unknown
Alabama 7,039 3% 97% 0.04% 3,865 4% 96% 0%
Alaska 243 12% 88% 0% 78 23% 77% 0%
American Samoa -- -- -- -- -- -- -- --
Arizona 2,915 30% 70% 0% 2,782 39% 61% 0%
Arkansas 2,300 8% 92% 0.4% 1,734 8% 92% 0%
California 17,948 44% 53% 3% 30,079 47% 53% 0%
Colorado 2,236 10% 90% 0.2% 5,515 30% 70% 0%
Connecticut 2,425 36% 64% 0% 1,624 27% 72% 2%
Delaware 1,532 7% 93% 0% 1,360 8% 92% 0%
District of Columbia 6,718 10% 90% 0% 821 22% 78% 0%
Federated States of Micronesia -- -- -- -- -- -- -- --
Florida 29,706 23% 77% 0.01% 23,764 32% 68% 0.02%
Georgia 10,413 7% 92% 0.2% 12,179 9% 91% 0%
Guam -- -- -- -- -- -- -- --
Hawaii 917 11% 89% 0.3% 443 14% 86% 0%
Idaho 268 20% 80% 0% 348 18% 82% 0%
Illinois 11,577 23% 76% 0.1% 8,942 27% 73% 0%
Indiana 3,539 10% 90% 0% 2,779 11% 89% 0%
Iowa 2,021 9% 91% 0% 734 15% 85% 0%
Kansas 1,300 13% 87% 0% 1,442 14% 86% 0%
Kentucky 4,692 7% 93% 0% 3,952 7% 93% 0%
Louisiana 5,913 5% 95% 0% 3,736 8% 92% 0%
Maine 771 5% 95% 0% 703 4% 96% 0%
Marshall Islands -- -- -- -- -- -- -- --
Maryland 10,880 5% 95% 0.02% 5,836 11% 89% 0%
Massachusetts 5,007 28% 72% 0% 5,606 30% 58% 13%
Michigan 3,767 8% 92% 0.1% 3,287 7% 93% 0%
Minnesota 2,886 10% 90% 0.3% 1,584 15% 85% 0%
Mississippi 2,688 2% 98% 0% 2,758 0% 0% 100%
Missouri 7,541 7% 93% 0% 4,237 7% 93% 0%
Montana 351 5% 95% 0% 260 5% 95% 0%
Nebraska 494 36% 64% 0% 943 21% 79% 0%
Nevada 4,051 29% 70% 1% 2,639 35% 65% 0%
New Hampshire 529 14% 86% 0% 493 13% 84% 3%
New Jersey 7,793 23% 77% 0% 5,786 37% 43% 2%
New Mexico 659 50% 50% 0% 465 62% 37% 0.4%
New York 20,133 36% 64% 0.1% 21,141 35% 65% 0.1%
North Carolina 10,613 8% 92% 0.01% 9,522 11% 89% 0%
North Dakota 317 5% 95% 0% 236 5% 95% 0%
Northern Mariana Islands -- -- -- -- -- -- -- --
Ohio 5,575 7% 93% 0% 4,160 7% 93% 0%
Oklahoma -- -- -- -- 2,111 11% 88% 1%
Oregon 1,336 15% 85% 0% 3,266 19% 73% 8%
Pennsylvania 14,367 14% 86% 0.03% 8,146 15% 85% 0%
Puerto Rico 6,763 97% 2% 1% 7,803 99% 1% 0.1%
Republic of Palau -- -- -- -- -- -- -- --
Rhode Island 752 30% 70% 0% 718 28% 72% 1%
South Carolina 10,388 4% 96% 0% 5,567 6% 94% 0%
South Dakota 387 8% 92% 0% 320 9% 91% 0%
Tennessee 8,886 5% 95% 0% 7,671 6% 94% 0%
Texas 23,036 37% 62% 0.1% 16,138 39% 61% 0%
Utah 1,174 27% 73% 0% 813 30% 70% 0%
Vermont 467 4% 96% 0% 448 7% 93% 0%
Virgin Islands (U.S.) 164 29% 71% 0% 126 21% 79% 0%
Virginia 5,717 12% 88% 0.2% 7,264 12% 87% 1%
Washington 5,868 17% 82% 0.1% 4,028 20% 80% 0%
West Virginia 1,281 3% 97% 0% 522 3% 97% 0%
Wisconsin 4,912 13% 86% 1% 1,783 17% 83% 0.2%
Wyoming 225 14% 86% 0% 170 14% 86% 0%
Total 283,480 21% 79% 0.3% 242,727 27% 71% 2%

Table 11

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2018 Part B Clients Served ≤12 Years 13-24 Years 25-44 Years 45-64 Years >64 Years Unknown Calendar Year 2018 ADAP Clients Served ≤12 Years 13-24 Years 25-44 Years 45-64 Years >64 Years Unknown
Alabama 7,039 0% 0% 0% 0% 0% 100% 3,865 0% 6% 58% 34% 1% 0%
Alaska 243 0% 0% 0% 0% 0% 100% 78 1% 1% 28% 56% 6% 6%
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 2,915 0.1% 2% 30% 56% 11% 0% 2,782 0% 3% 36% 50% 11% 0%
Arkansas 2,300 0.3% 6% 48% 41% 5% 0% 1,734 0.1% 6% 46% 43% 5% 0%
California 17,948 0.1% 2% 24% 40% 7% 26% 30,079 0% 2% 36% 50% 12% 0%
Colorado 2,236 2% 8% 9% 42% 39% 0% 5,515 3% 40% 27% 22% 8% 0%
Connecticut 2,425 0.04% 2% 23% 65% 10% 0% 1,624 0.1% 1% 25% 58% 16% 0.1%
Delaware 1,532 0% 1% 25% 60% 13% 0% 1,360 0% 2% 27% 58% 13% 0%
District of Columbia 6,718 1% 3% 37% 52% 8% 0% 821 0% 1% 32% 51% 17% 0%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 29,706 0.1% 3% 34% 54% 9% 0% 23,764 0.03% 3% 41% 51% 5% 0%
Georgia 10,413 0.2% 5% 44% 45% 6% 0% 12,179 0% 5% 55% 38% 2% 0%
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 917 0.1% 1% 15% 61% 23% 0% 443 0.2% 2% 23% 54% 21% 0%
Idaho 268 0.4% 2% 41% 50% 6% 0% 348 0% 3% 46% 45% 7% 0%
Illinois 11,577 0.1% 3% 40% 49% 8% 0% 8,942 0.1% 2% 41% 47% 9% 0%
Indiana 3,539 0.1% 3% 43% 47% 8% 0% 2,779 0.1% 2% 45% 45% 8% 0%
Iowa 2,021 0.2% 4% 39% 50% 6% 0% 734 0% 4% 40% 49% 7% 0%
Kansas 1,300 0% 5% 35% 53% 7% 0% 1,442 0% 5% 39% 50% 7% 0%
Kentucky 4,692 0.3% 0.2% 8% 73% 18% 0% 3,952 0.1% 1% 45% 35% 18% 0%
Louisiana 5,913 0.1% 4% 43% 47% 7% 0% 3,736 0% 2% 40% 49% 9% 0%
Maine 771 1% 2% 27% 59% 12% 0% 703 0.3% 1% 27% 60% 12% 0%
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 10,880 1% 4% 33% 53% 8% 0.01% 5,836 0.1% 1% 32% 53% 14% 0%
Massachusetts 5,007 0.02% 2% 27% 63% 9% 0% 5,606 0% 1% 23% 62% 15% 0%
Michigan 3,767 0.1% 4% 36% 53% 7% 0% 3,287 0.2% 2% 34% 52% 12% 0%
Minnesota 2,886 0.03% 4% 35% 52% 8% 0.3% 1,584 1% 4% 40% 47% 9% 0%
Mississippi 2,688 0% 8% 53% 35% 3% 0% 2,758 0% 0% 0% 0% 0% 100%
Missouri 7,541 2% 4% 42% 47% 5% 0% 4,237 1% 4% 50% 40% 4% 0%
Montana 351 0% 5% 68% 24% 3% 0% 260 0% 2% 35% 59% 4% 0%
Nebraska 494 0% 16% 56% 26% 2% 0% 943 0.1% 4% 44% 46% 5% 0%
Nevada 4,051 1% 5% 46% 43% 6% 0% 2,639 0% 3% 42% 45% 9% 0%
New Hampshire 529 0% 1% 26% 62% 11% 0% 493 0% 1% 25% 61% 11% 3%
New Jersey 7,793 3% 5% 32% 52% 9% 0% 5,786 0.1% 3% 40% 50% 7% 0%
New Mexico 659 0% 2% 34% 53% 11% 0% 465 0.4% 2% 31% 59% 8% 0%
New York 20,133 0.03% 2% 40% 49% 9% 0% 21,141 0.03% 2% 36% 51% 11% 0%
North Carolina 10,613 0.3% 4% 38% 51% 6% 0% 9,522 0% 4% 43% 46% 7% 0%
North Dakota 317 0.3% 6% 49% 40% 4% 0% 236 1% 6% 48% 41% 3% 0%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 5,575 0.04% 3% 37% 51% 9% 0% 4,160 0.02% 3% 37% 51% 9% 0%
Oklahoma -- -- -- -- -- -- -- 2,111 0% 3% 45% 46% 6% 0%
Oregon 1,336 0.1% 2% 31% 56% 11% 0% 3,266 0.1% 1% 30% 57% 12% 0%
Pennsylvania 14,367 1% 3% 34% 53% 9% 0% 8,146 0.01% 2% 33% 51% 14% 0%
Puerto Rico 6,763 0.1% 2% 23% 61% 14% 0% 7,803 0.04% 3% 30% 61% 6% 0%
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island 752 0% 6% 26% 59% 9% 0% 718 0% 1% 28% 57% 14% 0%
South Carolina 10,388 1% 4% 37% 50% 7% 0% 5,567 0.1% 4% 45% 46% 4% 0%
South Dakota 387 1% 3% 39% 52% 5% 0% 320 1% 3% 38% 53% 5% 0%
Tennessee 8,886 0.1% 4% 43% 48% 5% 0% 7,671 0.1% 4% 45% 46% 4% 0%
Texas 23,036 0.1% 4% 45% 46% 5% 0% 16,138 0.1% 3% 48% 44% 5% 0%
Utah 1,174 0% 3% 46% 47% 4% 0% 813 0% 3% 52% 42% 3% 0%
Vermont 467 0.2% 4% 9% 56% 31% 0% 448 0% 1% 19% 62% 18% 0%
Virgin Islands (U.S.) 164 1% 2% 23% 62% 13% 0% 126 1% 2% 42% 44% 12% 0%
Virginia 5,717 0.1% 4% 36% 52% 8% 0% 7,264 0.1% 4% 45% 45% 6% 0%
Washington 5,868 0.02% 2% 36% 53% 8% 0% 4,028 0% 2% 31% 56% 0% 12%
West Virginia 1,281 0.1% 3% 35% 54% 8% 0% 522 0% 5% 32% 54% 9% 0%
Wisconsin 4,912 3% 6% 36% 48% 7% 0% 1,783 0.2% 4% 40% 46% 9% 0%
Wyoming 225 0% 1% 21% 52% 25% 0% 170 1% 2% 36% 55% 6% 0%
Total 283,480 0.4% 3% 35% 49% 8% 4% 242,727 0.1% 4% 39% 47% 8% 1%

Table 12

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2018 Part B Clients Served Male Female Transgender Trans Women Trans Men Transgender - Other Unknown Calendar Year 2018 ADAP Clients Served Male Female Transgender Trans Women Trans Men Transgender - Other Unknown
Alabama 7,039 66% 33% 1% 98% 1% 1% 0.1% 3,865 75% 23% 2% 81% 19% 0% 0%
Alaska 243 67% 30% 2% 100% 0% 0% 0% 78 83% 17% 0% 0% 0% 0% 0%
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 2,915 83% 15% 1% 93% 7% 0% 0.2% 2,782 84% 14% 1% 94% 6% 0% 0%
Arkansas 2,300 76% 23% 0% 100% 0% 0% 0% 1,734 77% 22% 1% 100% 0% 0% 0%
California 17,948 76% 22% 2% 97% 3% 0% 0.2% 30,079 89% 10% 1% 98% 2% 1% 0.01%
Colorado 2,236 79% 18% 1% 45% 6% 48% 1% 5,515 83% 15% 1% 95% 5% 0% 0.04%
Connecticut 2,425 59% 39% 2% 92% 3% 5% 0% 1,624 68% 32% 0% 0% 0% 0% 0.1%
Delaware 1,532 65% 34% 1% 100% 0% 0% 0% 1,360 65% 34% 1% 100% 0% 0% 0%
District of Columbia 6,718 64% 32% 4% 100% 0% 0% 0.03% 821 71% 26% 3% 100% 0% 0% 0%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 29,706 71% 28% 1% 97% 3% 0% 0.1% 23,764 77% 23% 1% 91% 2% 6% 0%
Georgia 10,413 68% 31% 1% 48% 1% 52% 0.02% 12,179 78% 21% 2% 93% 2% 5% 0.02%
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 917 89% 9% 1% 100% 0% 0% 0.2% 443 90% 9% 1% 75% 25% 0% 0%
Idaho 268 73% 26% 1% 50% 0% 50% 0% 348 81% 18% 1% 67% 0% 33% 0%
Illinois 11,577 78% 20% 2% 90% 10% 1% 0% 8,942 80% 18% 2% 91% 9% 0% 0%
Indiana 3,539 75% 24% 1% 94% 6% 0% 0% 2,779 78% 21% 1% 94% 6% 0% 0%
Iowa 2,021 75% 24% 1% 91% 9% 0% 0% 734 79% 20% 1% 100% 0% 0% 0%
Kansas 1,300 78% 20% 1% 94% 6% 0% 0% 1,442 81% 18% 1% 95% 5% 0% 0%
Kentucky 4,692 78% 21% 1% 100% 0% 0% 0% 3,952 78% 20% 1% 100% 0% 0% 0%
Louisiana 5,913 72% 26% 2% 42% 0% 58% 0% 3,736 77% 22% 1% 100% 0% 0% 0%
Maine 771 72% 27% 1% 100% 0% 0% 0% 703 75% 24% 1% 100% 0% 0% 0%
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 10,880 61% 37% 1% 85% 12% 4% 0.1% 5,836 65% 35% 0.3% 89% 11% 0% 0%
Massachusetts 5,007 63% 36% 0% 100% 0% 0% 1% 5,606 70% 29% 1% 85% 6% 9% 0.2%
Michigan 3,767 78% 21% 1% 94% 6% 0% 0% 3,287 82% 18% 1% 100% 0% 0% 0%
Minnesota 2,886 69% 29% 2% 87% 10% 3% 0% 1,584 71% 24% 1% 88% 6% 6% 4%
Mississippi 2,688 74% 26% 1% 100% 0% 0% 0% 2,758 0% 0% 0% 0% 0% 0% 100%
Missouri 7,541 77% 21% 2% 100% 0% 0% 0% 4,237 80% 18% 2% 100% 0% 0% 0%
Montana 351 84% 16% 1% 100% 0% 0% 0% 260 93% 7% 0% 0% 0% 0% 0%
Nebraska 494 76% 24% 0% 0% 0% 0% 0% 943 20% 79% 1% 91% 9% 0% 0%
Nevada 4,051 81% 17% 2% 97% 1% 1% 0.05% 2,639 84% 15% 1% 95% 3% 3% 0%
New Hampshire 529 73% 26% 1% 83% 17% 0% 0% 493 72% 24% 1% 83% 17% 0% 3%
New Jersey 7,793 60% 39% 1% 0% 0% 100% 0.01% 5,786 70% 29% 1% 91% 9% 0% 0%
New Mexico 659 86% 13% 1% 100% 0% 0% 0% 465 89% 10% 1% 100% 0% 0% 0%
New York 20,133 78% 22% 1% 0% 0% 100% 0.02% 21,141 77% 23% 1% 0% 0% 100% 0.01%
North Carolina 10,613 73% 26% 1% 98% 1% 1% 0% 9,522 74% 25% 1% 100% 0% 0% 0%
North Dakota 317 62% 38% 0% 0% 0% 0% 0% 236 61% 39% 0% 0% 0% 0% 0%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 5,575 80% 18% 1% 100% 0% 0% 0.2% 4,160 83% 16% 1% 100% 0% 0% 0%
Oklahoma -- -- -- -- -- -- -- -- 2,111 82% 17% 1% 77% 9% 14% 1%
Oregon 1,336 79% 20% 1% 80% 13% 7% 0% 3,266 88% 11% 0.5% 88% 6% 6% 0%
Pennsylvania 14,367 67% 30% 2% 91% 5% 4% 0.5% 8,146 75% 23% 1% 94% 6% 0% 1%
Puerto Rico 6,763 66% 34% 0% 100% 0% 0% 0% 7,803 67% 33% 0.2% 100% 0% 0% 0%
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island 752 62% 36% 1% 91% 9% 0% 0% 718 75% 24% 1% 0% 0% 100% 0%
South Carolina 10,388 67% 32% 1% 100% 0% 0% 0% 5,567 74% 25% 1% 97% 3% 0% 0%
South Dakota 387 65% 34% 0% 100% 0% 0% 0% 320 65% 35% 0.3% 100% 0% 0% 0%
Tennessee 8,886 74% 25% 1% 98% 1% 1% 0% 7,671 77% 22% 1% 98% 1% 1% 0%
Texas 23,036 77% 18% 1% 99% 1% 0% 4% 16,138 76% 22% 1% 0% 0% 100% 0.1%
Utah 1,174 84% 15% 0% 0% 0% 0% 0.4% 813 86% 13% 0% 0% 0% 0% 0.5%
Vermont 467 83% 16% 0% 0% 100% 0% 0% 448 81% 18% 1% 33% 67% 0% 0%
Virgin Islands (U.S.) 164 50% 49% 1% 100% 0% 0% 0% 126 52% 48% 0% 0% 0% 0% 0%
Virginia 5,717 68% 31% 1% 99% 1% 0% 0% 7,264 73% 25% 2% 100% 0% 0% 0%
Washington 5,868 80% 19% 1% 91% 8% 1% 0.1% 4,028 83% 15% 1% 84% 16% 0% 1%
West Virginia 1,281 77% 22% 0% 100% 0% 0% 0% 522 84% 16% 0.2% 100% 0% 0% 0%
Wisconsin 4,912 75% 23% 2% 94% 5% 1% 0.02% 1,783 81% 17% 2% 85% 15% 0% 0%
Wyoming 225 79% 21% 0% 100% 0% 0% 0% 170 83% 17% 0% 0% 0% 0% 0%
Total 283,480 72% 26% 1% 86% 3% 10% 0.4% 242,727 77% 21% 1% 84% 3% 13% 1%

Table 13

Scroll or click the table to use your arrow keys

State/Territory Financial Eligibility 1 Calendar Year 2017 Part B Clients Served ≤100% FPL 101-138% 1 FPL 101-138% 1 FPL 139-200% FPL 201-300% FPL 301-400% FPL >400% FPL Unknown Financial Eligibility Calendar Year 2016 ADAP Clients Served ≤100% FPL 101-138% 1 FPL 139-200% FPL 201-300% FPL 301-400% FPL >401% FPL Unknown
Part B Core Medical Services Part B Support Services Full-Pay Medication Program ADAP-Funded Insurance Program
Alabama 400% FPL 400% FPL 7,039 63% 11% 8% 3% 5% 1% 9% 400% FPL 400% FPL 3,865 71% 9% 12% 5% 4% 0% 0%
Alaska 400% FPL2 400% FPL2 243 0% 0% 0% 0% 0% 0% 100% 400% FPL 400% FPL 78 0% 0% 0% 0% 0% 0% 100%
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 400% FPL 400% FPL 2,915 42% 14% 14% 15% 8% 3% 4% 400% FPL 400% FPL 2,782 27% 13% 22% 25% 11% 2% 0.3%
Arkansas 500% FPL 500% FPL 2,300 44% 14% 14% 8% 12% 1% 6% 500% FPL 500% FPL 1,734 43% 13% 16% 15% 7% 0.5% 5%
California None None 17,948 43% 10% 9% 6% 2% 1% 29% 500% FPL 500% FPL 30,079 25% 9% 21% 21% 13% 10% 0.1%
Colorado 500% FPL 500% FPL 2,236 24% 8% 9% 7% 3% 3% 45% 500% FPL 500% FPL 5,515 39% 12% 15% 9% 18% 6% 0%
Connecticut 300% FPL 300% FPL 2,425 59% 12% 14% 9% 0% 1% 5% 400% FPL 400% FPL 1,624 22% 16% 28% 0% 0% 2% 33%
Delaware 300% FPL3 300% FPL3 1,532 52% 12% 15% 12% 6% 3% 0% 500% FPL 500% FPL 1,360 44% 12% 15% 16% 8% 5% 0%
District of Columbia 500% FPL 500% FPL 6,718 49% 5% 8% 4% 3% 1% 31% 500% FPL 500% FPL 821 34% 15% 14% 0% 30% 7% 0%
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 400% FPL 400% FPL 29,706 48% 12% 16% 13% 5% 0.4% 6% 400% FPL 400% FPL 23,764 46% 12% 19% 17% 6% 0% 0%
Georgia 400% FPL 400% FPL 10,413 52% 12% 11% 8% 3% 0% 14% 400% FPL 400% FPL 12,179 59% 11% 15% 11% 3% 0% 1%
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 400% FPL 400% FPL 917 34% 17% 0% 5% 3% 0% 41% 400% FPL 400% FPL 443 26% 20% 29% 19% 6% 0.5% 0%
Idaho 200% FPL 200% FPL 268 57% 17% 16% 3% 1% 1% 6% 200% FPL 200% FPL 348 46% 17% 22% 3% 1% 0.3% 11%
Illinois 500% FPL 500% FPL 11,577 47% 9% 16% 16% 8% 4% 0.2% 500% FPL 500% FPL 8,942 39% 9% 19% 19% 9% 5% 0%
Indiana 300% FPL 300% FPL 3,539 46% 15% 20% 18% 1% 0.2% 0% 300% FPL 300% FPL 2,779 40% 14% 23% 22% 0.4% 0.2% 0%
Iowa 400% FPL 400% FPL 2,021 38% 10% 14% 19% 8% 6% 4% 400% FPL 400% FPL 734 17% 7% 23% 35% 15% 2% 1%
Kansas 400% FPL 400% FPL 1,300 52% 14% 13% 13% 8% 0% 0% 400% FPL 400% FPL 1,442 45% 13% 16% 18% 8% 0% 0%
Kentucky 500% FPL 500% FPL 4,692 52% 13% 9% 7% 14% 3% 0.5% 500% FPL 500% FPL 3,952 51% 12% 14% 12% 9% 2% 0.1%
Louisiana 400% FPL 400% FPL 5,913 38% 10% 21% 20% 10% 0.1% 0.4% 400% FPL 400% FPL 3,736 12% 11% 31% 31% 15% 0.1% 0%
Maine 300% FPL4 300% FPL 771 45% 16% 16% 17% 3% 1% 0% 500% FPL 500% FPL 703 32% 10% 16% 25% 11% 6% 0%
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 500% FPL 500% FPL 10,880 56% 10% 7% 6% 3% 1% 17% 500% FPL 500% FPL 5,836 20% 11% 19% 24% 17% 9% 0%
Massachusetts 500% FPL 500% FPL 5,007 59% 10% 9% 8% 4% 3% 6% 500% FPL 500% FPL 5,606 42% 10% 13% 16% 12% 7% 0%
Michigan 500% FPL 500% FPL 3,767 49% 15% 16% 12% 4% 2% 2% 500% FPL 500% FPL 3,287 13% 12% 29% 28% 13% 5% 0.4%
Minnesota 400% FPL 400% FPL 2,886 58% 11% 15% 11% 4% 0.4% 1% 400% FPL 400% FPL 1,584 21% 5% 19% 27% 28% 0% 0%
Mississippi 400% FPL 400% FPL 2,688 32% 14% 18% 7% 4% 0% 25% 400% FPL 400% FPL 2,758 0% 0% 0% 0% 0% 0% 100%
Missouri 300% FPL 300% FPL 7,541 56% 12% 14% 16% 2% 0% 0% 300% FPL 300% FPL 4,237 52% 9% 16% 21% 2% 0% 0%
Montana 500% FPL 500% FPL 351 57% 16% 8% 3% 7% 4% 5% 500% FPL 500% FPL 260 39% 18% 22% 15% 4% 1% 0%
Nebraska 300% FPL 300% FPL 494 5% 65% 12% 18% 0% 0% 0% 300% FPL 300% FPL 943 40% 14% 18% 23% 5% 1% 0%
Nevada 400% FPL 400% FPL 4,051 37% 12% 16% 15% 7% 0% 13% 400% FPL 400% FPL 2,639 28% 15% 22% 23% 11% 0.3% 0%
New Hampshire 500% FPL 500% FPL 529 25% 14% 20% 24% 14% 3% 0% 500% FPL 500% FPL 493 21% 13% 20% 25% 15% 3% 3%
New Jersey 500% FPL 500% FPL 7,793 35% 11% 9% 9% 4% 6% 1% 500% FPL 500% FPL 5,786 25% 7% 15% 25% 16% 12% 0%
New Mexico 400% FPL 400% FPL 659 33% 18% 24% 21% 3% 0% 0% 400% FPL 400% FPL 465 26% 9% 25% 25% 10% 0% 4%
New York 435% FPL 435% FPL 20,133 36% 9% 16% 18% 14% 7% 0% 435% FPL 435% FPL 21,141 38% 9% 15% 18% 14% 7% 0%
North Carolina 300% FPL 300% FPL 10,613 55% 11% 10% 7% 0% 0% 18% 300% FPL 300% FPL 9,522 54% 15% 18% 13% 0% 0% 0%
North Dakota 400% FPL 400% FPL 317 40% 12% 17% 17% 13% 1% 0% 400% FPL 500% FPL 236 32% 11% 20% 21% 15% 1% 0%
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 300% FPL 300% FPL 5,575 40% 13% 20% 26% 0% 0% 0% 300% FPL 300% FPL 4,160 32% 13% 24% 30% 0.2% 0% 0%
Oklahoma 400% FPL 400% FPL -- -- -- -- -- -- -- -- 400% FPL 400% FPL 2,111 44% 15% 18% 10% 14% 0% 0%
Oregon 300% FPL5 300% FPL5 1,336 53% 15% 15% 11% 4% 2% 0.3% 500% FPL 500% FPL 3,266 32% 13% 18% 20% 11% 5% 0%
Pennsylvania 500% FPL 500% FPL 14,367 54% 10% 13% 10% 5% 7% 0% 500% FPL 500% FPL 8,146 23% 11% 16% 22% 15% 12% 0.2%
Puerto Rico 200% FPL 200% FPL 6,763 99% 1% 0.5% 0% 0% 0% 0% 200% FPL 200% FPL 7,803 98% 0.5% 1% 0% 0% 0% 0%
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island 500% FPL 500% FPL 752 76% 11% 8% 4% 1% 0% 0% 500% FPL 500% FPL 718 30% 57% 13% 0% 0% 0% 0%
South Carolina 550% FPL 550% FPL 10,388 55% 11% 12% 6% 9% 3% 3% 550% FPL 550% FPL 5,567 46% 8% 15% 17% 9% 5% 0%
South Dakota 300% FPL 300% FPL 387 46% 11% 18% 23% 0% 0% 2% 300% FPL 300% FPL 320 46% 10% 18% 24% 0% 0% 2%
Tennessee 400% FPL 400% FPL 8,886 50% 11% 14% 15% 11% 0% 0% 400% FPL 400% FPL 7,671 46% 10% 14% 17% 12% 0% 0%
Texas 500% FPL 500% FPL 23,036 54% 14% 9% 8% 2% 1% 11% 200% FPL 200% FPL 16,138 51% 15% 31% 3% 0.3% 0.2% 0%
Utah 250% FPL 250% FPL 1,174 49% 11% 13% 26% 0% 0% 0% 250% FPL 250% FPL 813 52% 10% 14% 24% 0% 0% 0%
Vermont 500% FPL 500% FPL 467 31% 16% 13% 9% 19% 13% 0% 500% FPL 500% FPL 448 38% 13% 16% 12% 17% 4% 0%
Virgin Islands (U.S.) 300% FPL 300% FPL 164 58% 13% 12% 6% 7% 4% 1% 300% FPL 300% FPL 126 40% 10% 17% 11% 13% 4% 5%
Virginia 500% FPL 500% FPL 5,717 46% 13% 15% 13% 7% 2% 4% 500% FPL 500% FPL 7,264 49% 11% 16% 9% 13% 3% 0.2%
Washington 425% FPL6 425% FPL 5,868 45% 17% 13% 13% 7% 4% 1% 425% FPL 425% FPL 4,028 24% 13% 22% 26% 14% 2% 0.02%
West Virginia 400% FPL 400% FPL 1,281 29% 16% 18% 20% 14% 1% 0% 500% FPL 400% FPL8 522 25% 19% 26% 11% 17% 2% 0%
Wisconsin 500% FPL 500% FPL 4,912 61% 11% 10% 6% 7% 4% 1% 300% FPL 300% FPL 1,783 22% 13% 24% 35% 2% 0% 3%
Wyoming 500% FPL7 500% FPL7 225 0% 17% 13% 16% 9% 7% 39% 500% FPL 500% FPL 170 33% 15% 12% 19% 12% 9% 0%
Total 283,480 49% 11% 12% 11% 5% 2% 8% 242,727 40% 11% 18% 16% 9% 4% 2%

Table 14

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2018 Clients Served Medicaid Only Medicare Only Medicaid and Medicare Private Insurance Coverage No Form of Insurance Unknown
Enrolled in QHP on the ACA Marketplace Enrolled in Plan off the ACA Marketplace Enrolled in Other Private Insurance Unknown Total Private Insurance
Alabama 3,865 0 0 99 0 2,650 0 0 2,650 1,116 0
Alaska 78 0 0 15 16 9 18 1 44 18 1
American Samoa -- -- -- -- -- -- -- -- -- -- --
Arizona 2,782 310 114 827 310 0 236 263 809 809 722
Arkansas 1,734 266 206 167 0 0 0 440 440 655 0
California 30,079 38 4,139 4,472 3,101 872 4,232 1,756 9,961 11,469 0
Colorado 5,515 1,191 795 661 699 279 1,350 0 2,328 540 0
Connecticut 1,624 0 0 0 0 0 0 612 612 1,012 0
Delaware 1,360 384 158 269 171 0 319 0 490 59 0
District of Columbia 821 0 19 92 121 31 16 0 168 542 0
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- --
Florida 23,764 305 66 1,599 5,514 34 1,064 105 6,717 15,077 0
Georgia 12,179 110 0 704 888 0 550 0 1,438 9,728 199
Guam -- -- -- -- -- -- -- -- -- -- --
Hawaii 443 2 5 177 60 15 103 0 178 81 0
Idaho 348 86 0 53 0 0 2 2 4 205 0
Illinois 8,942 1,357 185 1,005 1,413 599 1,114 5 3,131 3,264 0
Indiana 2,779 0 0 0 0 0 0 0 0 2,779 0
Iowa 734 54 43 120 6 283 150 0 439 76 2
Kansas 1,442 47 171 208 503 19 298 0 820 125 71
Kentucky 3,952 1,190 558 410 700 230 262 0 1,192 601 1
Louisiana 3,736 0 25 1,115 1,577 34 715 0 2,326 270 0
Maine 703 269 156 34 31 58 92 0 181 63 0
Marshall Islands -- -- -- -- -- -- -- -- -- -- --
Maryland 5,836 0 0 1,544 1,056 536 1,524 2 3,118 936 238
Massachusetts 5,606 2,133 1,085 480 507 853 274 0 1,634 170 104
Michigan 3,287 0 0 555 986 0 1,109 0 2,095 637 0
Minnesota 1,584 140 0 262 232 192 466 0 890 292 0
Mississippi 2,758 0 0 0 0 0 0 0 0 2,758 0
Missouri 4,237 255 94 316 2,000 26 855 0 2,881 691 0
Montana 260 4 0 67 43 0 71 0 114 75 0
Nebraska 943 10 0 121 0 392 185 0 577 235 0
Nevada 2,639 0 0 581 390 63 594 0 1,047 1,011 0
New Hampshire 493 40 32 142 83 19 69 0 171 92 0
New Jersey 5,786 0 510 0 0 0 0 2,069 2,069 3,207 0
New Mexico 465 0 12 104 119 131 34 0 284 12 53
New York 21,141 489 289 4,686 0 0 0 7,022 7,022 8,655 0
North Carolina 9,522 0 0 1,773 462 0 0 0 462 7,287 0
North Dakota 236 24 8 17 34 4 97 0 135 52 0
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- --
Ohio 4,160 611 38 1,359 597 305 428 0 1,330 822 0
Oklahoma 2,111 0 69 355 828 0 256 0 1,084 603 0
Oregon 3,266 502 232 968 497 234 683 0 1,414 150 0
Pennsylvania 8,146 1,628 452 1,879 0 0 0 2,290 2,290 1,415 482
Puerto Rico 7,803 7,409 0 29 0 0 280 0 280 85 0
Republic of Palau -- -- -- -- -- -- -- -- -- -- --
Rhode Island 718 0 79 142 0 0 0 274 274 223 0
South Carolina 5,567 0 0 277 1,526 179 763 396 2,864 2,426 0
South Dakota 320 35 2 61 20 109 54 0 183 39 0
Tennessee 7,671 125 0 666 3,000 430 1,707 0 5,137 1,743 0
Texas 16,138 0 0 1,955 0 0 436 0 436 13,747 0
Utah 813 0 0 40 5 391 86 0 482 291 0
Vermont 448 151 51 102 62 2 70 0 134 10 0
Virgin Islands (U.S.) 126 0 0 22 0 0 25 0 25 79 0
Virginia 7,264 0 0 624 3,963 0 542 0 4,505 2,135 0
Washington 4,028 0 813 857 735 339 503 20 1,597 248 513
West Virginia 522 12 49 82 41 4 240 0 285 94 0
Wisconsin 1,783 10 69 177 380 0 381 0 761 766 0
Wyoming 170 8 2 42 63 31 0 0 94 24 0
Total 242,727 19,195 10,526 32,312 32,739 9,353 22,253 15,257 79,602 99,499 2,386

Section Three

Expanding and Adapting Service Delivery in a Changing Healthcare Landscape

Capitalizing on opportunities to expand the reach and breadth of services

Since its implementation, the ACA has allowed RWHAP Part B programs and ADAPs to shift expenditures associated with paying the full cost for clients’ medications to critical program improvements and service delivery expansions (e.g., raising the income limit for client eligibility, increasing funding for new and/or existing services). Federal/state policies, including those that impact the ACA and overall access to insurance, could impede RWHAP Part B programs’ and ADAPs’ effectiveness and contributions to the goals of the EHE.

The ACA has enabled tens of thousands of PLWH, including RWHAP Part B/ADAP clients, to transition to expanded Medicaid and private insurance available through Marketplaces. The ACA’s public and private insurance expansions have had a profound impact on RWHAP Part B programs and ADAPs and the clients they serve despite fluctuations in federal and state policy affecting Medicaid and private insurance. RWHAP Part B programs and ADAP continues to support more clients than ever to afford private insurance coverage. In 2018, 32 RWHAP Part B programs reported having provided services to 45,902 clients under Health Insurance Premium and Cost-Sharing Assistance for Low-Income Individuals, representing $24,954,812 or 1% of the total RWHAP Part B budget.

RWHAP Part B programs and ADAPs have been able to repurpose expenditures associated with paying the full cost for medications by migrating clients towards Medicaid (particularly in those states that have expanded Medicaid) or enrolling them in less costly and more comprehensive insurance coverage. This has created opportunities for shifting funds towards expanding other RWHAP Part B core medical/services as well as key programmatic costs, including clinical quality management (CQM) (i.e., a series of activities that focus on enhancing the quality of HIV care provided and increasing access to services) and program administration (e.g., planning and evaluation, salaries, and data system management and reporting). Of note, six of the eight jurisdictions with the highest rates of viral load suppression among RWHAP Part B clients are those in which Medicaid eligibility has expanded to at least 139% of FPL.

Between 2017 and 2018, the core medical services in which the greatest number of jurisdictions have reported increases in the number of clients served and/or expenditures include: Medical Case Management (n=37); Mental Health Services (n=32); Outpatient Ambulatory Health Services (n=32); and Oral Health Care (n=32). The support services in which the greatest number of jurisdictions have reported expansion in clients served/expenditures include: Case Management (Non-Medical) (n=35); Medical Transportation Services (n=35); Housing Services (n=31); Food Bank/Home-Delivered Meals (n=30); and Emergency Financial Assistance (n=27). Under program administration, 27 RWHAP Part B programs reported having increased expenditures while 29 ADAPs reported such increases. Jurisdictions have also made significant increases in expenditures for CQM across RWHAP Part B (n=23) and ADAP (n=9). By bolstering service delivery and programmatic activities that ensure their clients’ sustained viral load suppression, RWHAP Part B programs and ADAPs may therefore accelerate their jurisdictions’ achievement of ends to the HIV epidemics, both directly and indirectly.

Key Policy Changes’ Impact on RWHAP Part B and ADAP

  View Larger

Chart 13

ADAP Clients Served, by ACA Marketplace Type

ADAP Clients Served, by ACA Marketplace Type

  View Larger

Chart 14

ADAP Clients Served by Insurance Continuation, by Insurance Payment Type, Calendar Year 2018

ADAP Clients Served by Insurance Continuation, by Insurance Payment Type, Calendar Year 2018

  View Larger

Chart 15

ADAP Clients Served, by State Medicaid Expansion, Calendar Year 2018

ADAP Clients Served, by State Medicaid Expansion, Calendar Year 2018

The percentage of ADAP clients served by the ADAP-funded insurance program has grown 19% between 2013 (i.e., the last year before full ACA implementation) and 2018, with a 3% average increase per year. As of December 31, 2018, 33% were enrolled in private insurance (e.g., individual market plans purchased on or off Marketplaces and employer-sponsored coverage). Among clients served who were enrolled in private insurance, 41% were enrolled in a qualified health plan (QHP) on the ACA Marketplace. Yet the health care policy landscape in which ADAPs and the clients they serve have accessed insurance continues to experience a great deal of flux and instability.

In late 2017, the Administration abruptly stopped cost-sharing reduction payments to issuers, meaning that issuers were still required to offer eligible low-income consumers lower-cost plan design options, but those issuers were no longer being compensated by the federal government. In response, issuers raised premiums dramatically in 2018 to make up the difference. While many individuals who were eligible for subsidized plans were insulated from the premium increases (the amount of premium tax credits is pegged to the cost of the lowest cost silver level plan in a geographic area, meaning the amount of tax credit increases as the premium amount increases), individuals purchasing off-Marketplace unsubsidized plans were most impacted. These policy changes made it more challenging for ADAPs to support clients to purchase cost-effective private insurance, particularly in the off-Marketplace individual market. The majority of clients served by the ADAP-funded insurance program in calendar year 2018 (53%) received premium assistance, a decrease from the 56% supported in CY2017. Premiums represented 57% of all ADAP insurance expenditures (a 32% increase from calendar year 2017). Nationally, increases have occurred in consumer cost-sharing (i.e., higher deductibles and co-payments/co-insurance) across both the individual market and employer-sponsored plans. Between 2017 and 2018, ADAP insurance expenditures for co-payments/co-insurance and deductibles have increased 10% as 33 ADAPs report high co-payments/co-insurance for HIV medications to be challenging. Finally, issuer departures from Marketplaces continued to occur in 2018 following the phasing out of the ACA’s federal reinsurance program. Twenty-one ADAPs reported changes in on-Marketplace plan availability, including 19 with fewer plans offered. Taken together, each of these challenge ADAPs’ ability to provide robust and effective insurance access and support to their clients.

As safety net providers of medication access, ADAPs are charged with filling any gaps that may occur in their clients’ Medicaid coverage as a result of churn between both programs, clients’ challenges in meeting Medicaid eligibility requirements, etc. Twelve percent of ADAP clients were eligible for Medicaid; these clients include those who may have begun the year as non-Medicaid eligible but who became eligible later and/or those for whom ADAP has chosen to provide wrap-around coverage. To that end, 25 ADAPs reported covering Medicaid co-payments during this period. In 2018, 42% of ADAP clients served with incomes below 139% FPL resided in a non-Medicaid expansion state while 5 of the ten jurisdictions with the highest ADAP utilization had not expanded Medicaid (i.e., Florida, Georgia, North Carolina, Puerto Rico, and Texas).

Each jurisdiction may also choose to submit what is known as an 1115 waiver to the U.S. Department of Health and Human Services (HHS) to “waive” certain federal Medicaid eligibility requirements. Jurisdictions may use waiver proposals to expand eligibility to populations not typically covered by Medicaid or to test innovative strategies in delivering health care. Yet many of the 1115 waivers approved since 2017 include provisions that could make it more difficult for individuals, including PLWH, to enroll in Medicaid or access necessary benefits (e.g., instituting work requirements, establishing premiums to enrollees, setting enrollment limits and lifetime caps). As of December 31, 2018, ten states’ 1115 waivers with such provisions were approved by HHS; these states’ ADAPs represented 8% of all ADAP clients served. While the details of how each of these policies are structured and implemented vary, all may result in their state’s ADAP having to re-enroll or expand services to impacted PLWH to fill the resulting gaps in Medicaid coverage and service delivery.

  View Larger

Chart 16

ADAP Clients Served by Medicaid Expansion State, by Viral Load, Calendar Year 2018

ADAP Clients Served by Medicaid Expansion State, by Viral Load, Calendar Year 2018

Effective antiretroviral (ARV) regimens have allowed many PLWH, including RWHAP Part B and ADAP clients, to achieve near-normal lifespans and experience fewer HIV-related conditions (e.g., opportunistic infections). As a result, the proportion of RWHAP Part B and ADAP clients who are older – and consequently facing an increased risk of non-HIV-related health complications (e.g., cardiovascular disease and cancer) – has and will continue to grow. In calendar year 2018, 8% of both RWHAP Part B and ADAP clients were aged 65 years or older. In 2008, 2% of ADAP clients served were aged 65 years or older, a significant shift over a ten-year interval.1 The proportion of ADAP clients who are Medicare-eligible has risen between 2014 and 2018, from 13% to 18%, a direct reflection of the overall aging of the PLWH population. Changes to Medicare policy will increasingly impact RWHAP Part B and ADAP clients as well as the programs that serve them.

Access to prescription drugs essential to the management of HIV and its associated comorbidities is contingent on their affordability. To maximize the use of ARV therapy – one of the four pillars of the EHE initiative – ADAPs must contend with rising drug costs. Mean list prices for standard first-line regimens have increased 77% over the past ten years, from approximately $27,400 in 2009 to nearly $44,000 in 2019. Voluntary discounting allowances under the 340B Drug Pricing Program, negotiations spearheaded by the ADAP Crisis Task Force (ACTF), and active industry engagement continue to play significant roles in getting the best possible discounted prices and rebating terms for ADAPs.

In coming years, the first long-acting injectables will come to market, providing RWAHAP Part B and ADAP clients with an opportunity to move from daily oral ARVs and maintain virologic suppression via monthly injections. As provider-administered products, they also pose unique challenges to ADAPs and Part B programs, notably the addition of product administration and other medical costs. This novel treatment paradigm will require new approaches to balancing cost containment with patient access.

ADAPs also continue to forge strong and sustainable partnerships with other 340B covered entities, including Part B subrecipients and other RWHAP grantees. While being cognizant of the 340B savings needs of safety net providers, ADAPs will need to sustain necessary levels of rebates on behalf of their ADAP-funded insurance clients to achieve cost-effectiveness and maintain the financial health of state RWHAP Part B programs.

Changes in policy in any of the above areas could have far-reaching impacts on RWHAP Part B programs and ADAPs, including their role in initiatives to end the HIV epidemics nationally and jurisdictionally. Public and private insurance policy is often set at the states level. This is particularly true as federal regulations cede more flexibilities to states to set standards for the ACA-compliant private insurance market and Medicaid. As such, each RWHAP Part B program and ADAP must therefore develop a customized, targeted response to these policy changes. They must remain flexible and well-funded to sustain, if not build on, the gains they have achieved.

1 RWHAP Part B program client data was first captured for calendar year 2015.

  View Larger

Chart 17

ADAP Clients Served and Estimated Expenditures in Insurance Purchasing and Continuation, 20181

ADAP Clients Served and Estimated Expenditures in Insurance Purchasing and Continuation, 2018<sup>1</sup>

Table 15

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2019 Estimated Expenditures Calendar Year 2018 Expenditures
Insurance Premiums Insurance Deductibles Insurance Co-payments/Co-insurance Other
Alabama $25,549,472 $18,987,370 $0 $2,450,596 $0
Alaska $367,420 $157,416 $0 $155,420 $0
American Samoa -- -- -- -- --
Arizona $7,776,785 $901,077 $99,040 $5,604,161 $1,264,099
Arkansas $1,500,000 $0 $0 $1,020,223 $0
California $85,995,406 $33,494,046 $0 $36,953,165 $0
Colorado $15,460,470 $5,210,030 $5,329,102 $907,681 $0
Connecticut $1,881,125 -- -- -- --
Delaware $1,500,000 $368,310 $0 $1,084,909 $0
District of Columbia $1,200,000 $990,917 $0 $288,900 $0
Federated States of Micronesia -- -- -- -- --
Florida $67,750,000 $35,906,852 $0 $21,995,842 $0
Georgia $5,443,045 $4,898,588 $0 $269,855 $0
Guam -- -- -- -- --
Hawaii $1,580,000 $737,072 $0 $633,240 $0
Idaho -- -- -- -- --
Illinois $22,500,000 $13,695,769 $705,850 $7,136,933 $0
Indiana -- -- -- -- --
Iowa $4,000,000 $2,435,195 $0 $908,423 $0
Kansas $2,500,000 $1,688,138 $0 $130,854 $0
Kentucky $5,875,000 $3,025,198 $2,043,300 $500,516 $0
Louisiana $20,815,725 $16,041,875 $779,490 $8,307,415 $0
Maine $2,528,115 $885,616 $0 $961,222 $0
Marshall Islands -- -- -- -- --
Maryland $20,000,000 $13,738,194 $5,309,205 $5,309,205 $0
Massachusetts $15,000,000 $9,054,210 $0 $3,902,805 $0
Michigan $18,000,000 $3,064,255 $0 $14,455,361 $0
Minnesota $1,003,667 $1,011,592 $0 $0 $0
Mississippi $100,000 $53,225 $0 $454 $0
Missouri $15,600,000 $19,820,820 $0 $891,759 $0
Montana $926,680 $312,421 $0 $342,918 $0
Nebraska $8,000,000 $3,975,011 $0 $3,752,206 $0
Nevada $4,500,000 $1,278,863 $500,000 $2,378,469 $0
New Hampshire $1,700,000 $834,341 $0 $795,204 $0
New Jersey $4,000,000 $3,715,799 $0 $0 $0
New Mexico $2,040,000 $1,754,345 $0 $76,495 $0
New York $55,000,000 $33,026,199 $0 $23,777,099 $0
North Carolina $6,000,000 $311,542 $0 $5,305,211 $0
North Dakota $225,000 $187,371 $0 $336,396 $0
Northern Mariana Islands -- -- -- -- --
Ohio $10,000,000 $4,765,802 $5,382 $5,075,213 $0
Oklahoma $9,000,000 $4,243,565 $0 $4,514,361 $0
Oregon $6,000,000 $4,502,460 $0 $1,079,433 $0
Pennsylvania $12,000,000 $491,662 $0 $11,218,634 $0
Puerto Rico $1,200,000 $0 $0 $1,032,771 $0
Republic of Palau -- -- -- -- --
Rhode Island $481,155 $400,911 $0 $0 $0
South Carolina $17,500,000 $8,430,406 $4,270,519 $3,957,313 $797,564
South Dakota $1,700,000 $1,130,266 $0 $678,783 $0
Tennessee $25,000,000 $15,239,838 $2,709,560 $5,802,684 $0
Texas $1,857,738 $1,102,357 $0 $1,035,404 $0
Utah $5,965,952 $2,378,085 $0 $2,299,756 $0
Vermont $500,000 $251,496 $0 $78,382 $0
Virgin Islands (U.S.) $55,000 $0 $0 $42,110 $0
Virginia $35,857,119 $26,743,909 $0 $16,222,915 $0
Washington $18,820,145 $13,533,030 $0 $6,929,319 $0
West Virginia $825,000 $170,800 $196,426 $525,209 $0
Wisconsin $7,800,500 $3,186,510 $0 $3,961,897 $0
Wyoming $924,000 $529,941 $53,864 $339,879 $0
Total $581,804,519 $318,662,696 $22,001,738 $215,427,001 $2,061,663

Table 16

Scroll or click the table to use your arrow keys

State/Territory Calendar Year 2018 Clients Served ADAP-Funded Insurance Premium Only1 Deductible / Co-pay / Co-insurance Only Premium and Deductible / Co-pay / Co-insurance
Alabama 2,749 373 8 2,368
Alaska 59 0 0 59
American Samoa -- -- -- --
Arizona 1,879 66 1,420 393
Arkansas 1,079 0 1,079 0
California 18,344 873 10,043 7,428
Colorado 4,975 0 1,335 3,640
Connecticut 612 111 0 501
Delaware 1,301 171 1,130 0
District of Columbia 279 168 111 0
Federated States of Micronesia -- -- -- --
Florida 8,687 167 3,171 5,349
Georgia 1,406 1,068 225 113
Guam -- -- -- --
Hawaii 362 120 153 89
Idaho -- -- -- --
Illinois 5,030 598 1,712 2,720
Indiana 1,612 247 723 642
Iowa 658 21 287 350
Kansas 1,317 0 513 804
Kentucky 3,351 0 2,400 951
Louisiana 3,466 462 1,278 1,726
Maine 658 101 360 197
Marshall Islands -- -- -- --
Maryland 4,802 355 2,201 2,246
Massachusetts 5,407 445 3,242 1,720
Michigan 2,650 288 1,194 1,168
Minnesota 1,292 262 392 638
Mississippi 32 -- -- --
Missouri 3,010 0 708 2,302
Montana 185 0 90 95
Nebraska 708 0 311 397
Nevada 1,720 240 987 493
New Hampshire 404 157 154 93
New Jersey 2,579 -- -- --
New Mexico 453 388 21 44
New York 13,130 36 0 5,391
North Carolina 2,235 0 1,975 260
North Dakota 183 0 125 58
Northern Mariana Islands -- -- -- --
Ohio 2,976 617 1,255 1,104
Oklahoma 1,654 254 525 875
Oregon 3,116 76 835 2,205
Pennsylvania 2,970 11 2,959 0
Puerto Rico 308 0 308 0
Republic of Palau -- -- -- --
Rhode Island 206 206 0 0
South Carolina 3,141 58 1,629 1,454
South Dakota 281 0 156 125
Tennessee 5,928 448 1,714 3,766
Texas 2,391 0 2,228 163
Utah 522 31 164 327
Vermont 438 0 216 222
Virgin Islands (U.S.) 47 0 47 0
Virginia 5,129 639 818 3,672
Washington 3,783 484 1,229 2,070
West Virginia 380 13 260 107
Wisconsin 1,017 289 0 728
Wyoming 146 0 126 20
Total 131,047 9,843 51,817 59,073

Table 17

Scroll or click the table to use your arrow keys

State/Territory Medicare Medicare Part D Subsidy Eligibility1 Total Medicare
Original Medicare Part B Only Medicare Advantage (i.e., Medicare Part C) Only Original Medicare Part B and Medicare Supplemental (i.e., Medigap) Unknown Full Subsidy Partial Subsidy Standard Benefit Advantage Plan with Part D Prescription Coverage Unknown
Alabama 0% 0% 0% 100% 0% 0% 100% 0% 0% 99
Alaska 0% 0% 0% 100% 100% 0% 0% 0% 0% 15
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona 86% 14% 1% 0% 30% 10% 59% 0% 1% 941
Arkansas 0% 0% 0% 100% 55% 45% 0% 0% 0% 373
California 0% 0% 0% 100% 2% 2% 83% 0% 13% 8,611
Colorado 0% 100% 0% 0% 28% 27% 45% 0% 0% 1,456
Connecticut 0% 0% 0% 0% 0% 0% 0% 0% 0% 0
Delaware 0% 0% 0% 100% 73% 4% 23% 0% 0% 427
District of Columbia 0% 0% 0% 100% 0% 0% 17% 0% 83% 111
Federated States of Micronesia -- -- -- -- -- -- -- -- -- --
Florida 92% 8% 0% 0% 1% 2% 90% 8% 0% 1,665
Georgia 97% 0% 0% 3% 44% 11% 44% 0% 1% 704
Guam -- -- -- -- -- -- -- -- -- --
Hawaii 25% 75% 0% 0% 2% 3% 20% 75% 1% 182
Idaho 0% 0% 0% 100% 0% 0% 0% 0% 100% 53
Illinois 0.1% 17% 45% 38% 23% 9% 52% 16% 0% 1,190
Indiana 0% 0% 0% 0% 0% 0% 0% 0% 0% 0
Iowa 0% 5% 0% 95% 26% 7% 63% 4% 0% 163
Kansas 0% 0% 0% 100% 56% 7% 28% 8% 0% 379
Kentucky 71% 19% 10% 0% 26% 6% 9% 1% 58% 968
Louisiana 2% 46% 51% 0% 39% 10% 28% 20% 3% 1,140
Maine 0% 0% 0% 100% 0% 0% 0% 0% 100% 190
Marshall Islands -- -- -- -- -- -- -- -- -- --
Maryland 58% 9% 32% 2% 21% 0% 30% 9% 41% 1,544
Massachusetts 0% 0% 13% 87% 0% 0% 25% 0% 75% 1,565
Michigan 0% 0% 0% 100% 17% 10% 73% 0% 0% 555
Minnesota 0% 99% 1% 0% 1% 0% 0% 99% 0% 262
Mississippi 0% 0% 0% 0% 0% 0% 0% 0% 0% 0
Missouri 88% 8% 4% 0% 24% 8% 45% 8% 15% 410
Montana 0% 0% 0% 100% 0% 0% 0% 0% 100% 67
Nebraska 0% 0% 0% 100% 46% 21% 7% 4% 22% 121
Nevada 0% 0% 0% 100% 54% 9% 28% 0% 9% 581
New Hampshire 99% 0% 1% 0% 49% 5% 46% 0% 0% 174
New Jersey 100% 0% 0% 0% 0% 0% 0% 0% 100% 510
New Mexico 0% 0% 0% 100% 0% 0% 0% 0% 100% 116
New York 0% 0% 0% 100% 43% 6% 51% 0% 0% 4,975
North Carolina 0% 0% 100% 0% 49% 35% 16% 0% 0% 1,773
North Dakota 68% 0% 32% 0% 100% 0% 0% 0% 0% 25
Northern Mariana Islands -- -- -- -- -- -- -- -- -- --
Ohio 0% 0% 0% 100% 52% 9% 38% 0% 0% 1,397
Oklahoma 0% 0% 0% 100% 48% 30% 22% 0% 0% 424
Oregon 40% 58% 0% 0.1% 25% 3% 11% 57% 2% 1,200
Pennsylvania 0% 0% 0% 100% 20% 3% 58% 7% 12% 2,331
Puerto Rico 0% 0% 0% 100% 0% 0% 0% 0% 100% 29
Republic of Palau -- -- -- -- -- -- -- -- -- --
Rhode Island 64% 0% 0% 36% 47% 3% 14% 0% 36% 221
South Carolina 84% 7% 0% 9% 9% 12% 72% 7% 0% 277
South Dakota 0% 0% 0% 100% 0% 0% 0% 0% 100% 63
Tennessee 0% 0% 0% 100% 5% 79% 16% 0% 0% 666
Texas 0% 0% 0% 121% 0% 0% 0% 0% 121% 1,955
Utah 100% 0% 0% 0% 30% 13% 57% 0% 0% 40
Vermont 33% 9% 31% 26% 33% 42% 16% 9% 0% 153
Virgin Islands (U.S.) 100% 0% 0% 0% 0% 0% 100% 0% 0% 22
Virginia 0% 0% 0% 100% 21% 11% 67% 0% 0% 624
Washington 0.3% 41% 0% 59% 34% 17% 49% 0% 0% 1,670
West Virginia 9% 11% 3% 77% 18% 24% 37% 21% 0% 131
Wisconsin 0% 0% 0% 100% 37% 35% 25% 0% 3% 246
Wyoming 102% 0% 0% 0% 41% 5% 50% 0% 7% 44
Total 16% 11% 9% 66% 23% 9% 47% 5% 18% 42,838

Table 18

Scroll or click the table to use your arrow keys

State/Territory Part B Core Medical Services Part B Core Medical Services
AIDS Drug Assistance Program Treatments Early Intervention Services (EIS) for Part B Health Insurance Premium and Cost-Sharing Assistance for Low-Income Individuals Home Health Care Home and Community-Based Health Services Hospice Services Local AIDS Pharmaceutical Assistance Medical Case Management Medical Nutrition Therapy Mental Health Services Outpatient and Ambulatory Health Services Oral Health Care Substance Use Services (Outpatient Care) Total Expenditures
Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures
Alabama 3,865 $30,684,935 77 $418,324 359 $91,707 0 $0 0 $0 0 $0 0 $0 3,252 $1,054,989 2,233 $57,712 1,417 $237,961 4,959 $897,961 661 $726,390 1,050 $261,632 $34,431,611
Alaska 78 $1,065,300 0 $0 45 $42,708 0 $0 0 $0 0 $0 0 $0 213 $171,087 8 $813 10 $4,650 45 $23,078 20 $7,849 32 $5,325 $1,320,810
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 2,782 $13,758,907 104 $631,974 265 $1,231,889 0 $0 0 $0 0 $0 0 $0 2,043 $1,711,301 0 $0 428 $276,502 1,390 $1,578,558 929 $436,962 103 $38,671 $19,664,764
Arkansas 1,734 $5,604,631 0 $0 263 $260,000 0 $0 0 $0 0 $0 0 $0 1,901 $532,060 221 $5,621 83 $83,000 1,158 $343,506 853 $633,668 0 $0 $7,462,486
California 30,079 $397,679,991 2,935 $3,308,793 27 $17,646 0 $0 109 $473,884 21 $574,366 0 $0 3,527 $3,559,011 453 $172,716 669 $594,366 3,164 $4,498,329 1,115 $806,953 46 $30,764 $411,716,819
Colorado 5,515 $18,599,905 268 $1,068,821 0 $0 0 $0 0 $0 0 $0 0 $0 219 $176,650 51 $12,753 143 $145,454 2 $60,436 137 $17,600 4 $35,810 $20,117,429
Connecticut 1,624 $7,098,314 19 $29,977 140 $27,713 0 $0 0 $0 0 $0 0 $0 1,595 $1,160,690 475 $117,717 53 $31,167 331 $87,151 197 $118,194 0 $0 $8,670,923
Delaware 1,360 $3,919,628 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 905 $557,837 0 $0 302 $165,937 1,532 $440,000 0 $0 0 $0 $5,083,402
District of Columbia 821 $17,150,784 354 $264,731 0 $0 0 $0 0 $0 0 $0 0 $0 3,317 $1,114,382 180 $36,056 891 $60,510 5,571 -- 0 $0 175 -- $18,626,463
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 23,764 $179,292,703 799 $698,649 29,706 $1,047,107 96 $44,971 30 $19,003 0 $0 4,543 $331,158 15,999 $4,437,585 1,642 $379,138 1,104 $115,904 18,953 $5,128,954 21,528 $1,650,874 11 $2,080 $193,148,126
Georgia 12,179 $71,915,881 0 $0 49 $20,388 0 $0 0 $0 0 $0 0 $0 9,084 $1,407,013 1,406 $76,870 1,624 $119,199 9,135 $4,319,477 2,082 $666,046 399 $10,174 $78,535,048
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 443 $2,095,486 0 $0 250 $105,633 0 $0 0 $0 0 $0 0 $0 917 $376,741 5 $760 86 $29,090 402 $390,467 139 $62,826 4 $1,164 $3,062,167
Idaho 348 $6,899,919 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 268 $325,000 0 $0 0 $0 68 $17,477 25 $10,954 0 $0 $7,253,350
Illinois 8,942 $54,608,424 0 $0 3,318 $12,895,407 0 $0 0 $0 0 $0 0 $0 4,896 $5,782,184 60 $1,700 193 $135,177 1,309 $701,340 765 $839,012 10 $11,570 $74,974,814
Indiana 2,779 $8,617,512 948 $1,298,660 0 $0 0 $0 0 $0 0 $0 0 $0 1,099 $892,096 612 $809,561 205 $400,427 191 $92,342 0 $0 6 $104,596 $12,215,194
Iowa 734 $4,444,093 -- -- 480 $280,162 0 $0 0 $0 0 $0 0 $0 958 $983,730 74 $2,830 378 $262,175 -- $661,441 37 $210,736 106 $24,141 $6,869,308
Kansas 1,442 $12,257,484 0 $0 -- $152,886 0 $0 0 $0 0 $0 0 $0 -- $244,090 0 $0 -- $50,886 -- $163,776 -- $184,485 -- $17,001 $13,070,608
Kentucky 3,952 $14,177,628 0 $0 0 $0 0 $0 131 $59,666 0 $0 0 $0 4,404 $2,074,849 53 $47,147 403 $180,898 3,455 $339,498 113 $1,057,521 21 $37,343 $17,974,550
Louisiana 3,736 $32,282,152 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 25 $1,469 0 $0 117 $55,538 0 $0 254 $163,133 30 $34,729 $32,537,021
Maine 703 $3,223,403 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 101 $140,901 0 $0 0 $0 0 $0 290 $304,317 0 $0 $3,668,621
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 5,836 $51,157,079 674 $5,562,087 44 $2,781 0 $0 62 $84,891 0 $0 0 $0 4,501 $5,833,206 602 $158,938 688 $775,361 3,765 $4,240,036 1,684 $1,747,120 158 $153,100 $69,714,599
Massachusetts 5,606 $19,064,767 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 4,313 $2,439,073 65 $90,000 0 $0 0 $0 334 $107,792 0 $0 $21,701,632
Michigan 3,287 $35,387,475 202 $460,870 230 $158,804 0 $0 0 $0 0 $0 0 $0 1,633 $2,317,517 34 $16,190 152 $138,619 748 $711,899 1,551 $450,646 3 $1,603 $39,643,623
Minnesota 1,584 $7,420,433 0 $0 72 $16,232 0 $0 0 $0 0 $0 0 $0 573 $402,873 130 $14,100 87 $5,647 0 $0 565 $137,983 0 $0 $7,997,268
Mississippi 2,758 $11,901,974 34 $88,734 32 $53,225 4 $42,441 0 $0 0 $0 0 $0 756 $120,508 46 $2,222 68 $18,486 1,302 $942,693 184 $249,226 0 $0 $13,419,509
Missouri 4,237 $59,774,944 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 7,231 $4,248,397 0 $0 73 $17,338 194 $190,917 1,107 $1,029,844 17 $10,734 $65,272,174
Montana 260 $1,536,197 0 $0 69 $77,678 0 $0 0 $0 0 $0 0 $0 323 $114,063 3 -- 30 -- 333 -- 75 -- 3 -- $1,727,938
Nebraska 943 $11,661,722 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 494 $548,602 0 $0 127 $27,032 228 $47,861 0 $0 0 $0 $12,285,217
Nevada 2,639 $19,532,956 627 $388,072 1,966 $1,876,657 0 $0 0 $0 0 $0 0 $0 1,798 $803,849 9 $14,253 543 $76,894 619 $354,999 0 $0 0 $0 $23,047,680
New Hampshire 493 $3,863,747 0 $0 341 $964,435 5 $1,555 0 $0 0 $0 0 $0 0 $0 0 $0 9 $3,890 92 $150,655 127 $112,021 8 $26,375 $5,122,678
New Jersey 5,786 $23,337,447 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 3,389 $2,053,444 250 $82,470 372 $333,200 1,379 $1,599,095 575 $590,916 0 $0 $27,996,572
New Mexico 465 $2,348,046 0 $0 126 $8,165 0 $0 0 $0 0 $0 0 $0 333 $188,080 0 $0 0 $0 2 $733 0 $0 0 $0 $2,545,024
New York 21,141 $384,181,746 0 $0 0 $0 192 -- 0 $0 0 $0 0 $0 1,184 -- 0 $0 0 $0 17,028 -- 2,896 -- 0 $0 $384,181,746
North Carolina 9,522 $57,613,076 0 $0 493 $124,205 0 $0 0 $0 0 $0 0 $0 4,209 $1,965,703 94 $68,511 500 $204,976 3,979 $5,291,125 781 $631,660 119 $129,738 $66,028,994
North Dakota 236 $1,539,919 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 142 $18,392 5 $512 5 $870 118 $118,126 30 $166,111 0 $0 $1,843,930
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 4,160 $33,536,182 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 4,562 $6,726,012 0 $0 111 $38,134 1,167 $255,937 1,177 $677,884 0 $0 $41,234,149
Oklahoma 2,111 $16,496,407 -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Oregon 3,266 $22,958,453 0 $0 17 $10,177 1 $345 11 $1,888 0 $0 0 $0 1,179 $531,901 14 $6,358 9 $12,500 42 $8,790 13 $13,173 0 $0 $23,543,585
Pennsylvania 8,146 $84,680,171 320 $317,561 1,601 $464,071 0 $0 8 $592 0 $0 0 $0 11,165 $6,370,459 0 $0 325 $133,315 2,118 $1,033,777 403 $389,824 150 $53,418 $93,443,188
Puerto Rico 7,803 $50,781,582 0 $0 0 $0 0 $0 549 $960,468 0 $0 0 $0 4,453 $570,582 1,111 $299,912 0 $0 4,849 $1,342,624 311 $297,372 0 $0 $54,252,540
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island 718 $7,688,381 16 $4,004,250 -- $517,445 0 $0 -- $380,155 0 $0 0 $0 -- $85,384 85 $92,224 175 $146,945 0 $0 68 $59,385 30 $566,418 $13,540,587
South Carolina 5,567 $33,961,714 -- $476,050 1,358 $645,680 0 $0 0 $0 0 $0 275 $35,949 8,954 $5,824,336 305 $19,100 1,408 $538,619 7,307 $5,625,485 1,532 $1,161,069 1,854 $89,511 $48,377,512
South Dakota 320 $3,198,597 0 $0 137 $1,130,266 0 $0 0 $0 0 $0 0 $0 385 $170,029 0 $0 11 $3,681 99 $57,323 96 $149,825 1 $200 $4,709,921
Tennessee 7,671 $40,991,707 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 6,786 $3,350,256 121 $7,810 144 $128,930 4,660 $2,506,434 1,630 $464,205 0 $0 $47,449,342
Texas 16,138 $72,134,939 677 $327,739 3,147 $1,817,426 0 $0 38 $38,768 0 $0 3,054 $614,491 4,558 $1,445,505 59 $8,710 463 $142,652 10,994 $7,659,141 4,004 $2,014,146 41 $13,727 $86,217,244
Utah 813 $8,930,422 320 $584,372 247 $43,968 0 $0 0 $0 0 $0 0 $0 923 $617,460 0 $0 0 $0 705 $807,824 271 $40,300 0 $0 $11,024,346
Vermont 448 $438,090 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 411 $55,679 272 $35,794 57 $81,567 458 $50,000 0 $0 0 $0 $661,130
Virgin Islands (U.S.) 126 $194,429 53 $25,000 0 $0 7 $2,700 0 $0 0 $0 0 $0 150 $30,000 0 $0 0 $0 143 $67,066 0 $0 0 $0 $319,195
Virginia 7,264 $58,495,887 17 $186,245 337 $150,403 0 $0 0 $0 0 $0 0 $0 2,677 $1,920,134 121 $52,703 1,075 $624,125 2,158 $2,839,225 1,994 $3,572,815 374 $279,514 $68,121,051
Washington 4,028 $28,570,242 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 5,868 $7,473,134 0 $0 90 $191,705 610 $40,305 172 $287,557 2 $162 $36,563,105
West Virginia 522 $3,519,457 0 $0 323 $33,489 0 $0 0 $0 0 $0 0 $0 1,269 $354,301 0 $0 5 $1,982 0 $0 311 $294,668 6 $5,353 $4,209,250
Wisconsin 1,783 $18,542,560 0 $0 393 $433,131 0 $0 0 $0 0 $0 0 $0 4,209 $4,218,955 0 $0 903 $1,264,107 3,592 $1,800,141 1,327 $598,862 111 $76,221 $26,933,977
Wyoming 170 $1,471,544 0 $0 67 $253,328 0 $0 0 $0 0 $0 0 $0 193 $58,600 4 $400 7 $3,000 15 $4,300 46 $31,000 1 $300 $1,822,472
Total 242,727 $2,062,289,371 8,444 $20,140,909 45,902 $24,954,812 305 $92,012 938 $2,019,315 21 $574,366 7,872 $981,598 143,344 $87,560,099 10,803 $2,691,601 15,543 $7,862,416 120,369 $57,490,302 52,409 $23,172,924 4,875 $2,021,374 $2,275,354,692

Table 19

Scroll or click the table to use your arrow keys

State/Territory Part B Support Services Part B Support Services
Child Care Services Emergency Financial Assistance Food Bank/Home-Delivered Meals Health Education/Risk Reduction Housing Services Legal Services Linguistic Services Medical Transportation Services Outreach Services Psychosocial Support Services Referral for Health Care/Support Services Rehabilitation Services Respite Care Substance Use Services (Residential) Treatment Adherence Counseling Total Expenditures
Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures Clients Served Program Expenditures
Alabama 0 $0 665 $341,007 1,474 $258,652 1,311 $102,688 222 $162,341 245 $108,221 71 $31,355 1,707 $314,165 0 $0 1,184 $70,935 594 $42,636 0 $0 0 $0 0 $0 0 $0 $2,581,252
Alaska 0 $0 0 $0 123 $24,996 0 $0 70 $102,066 1 $555 1 $652 69 $13,235 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $323,050
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona 0 $0 99 $80,686 220 $187,212 0 $0 117 $1,677,340 0 $0 1 $15,790 165 $18,991 0 $0 88 $108,429 0 $0 0 $0 0 $0 0 $0 22 $2,043 $2,873,761
Arkansas 0 $0 0 $0 1,621 $45,221 2,300 $1,000 0 $0 0 $0 12 $3,201 1,681 $28,142 0 $0 1,554 $56,678 0 $0 0 $0 0 $0 0 $0 0 $0 $1,043,984
California 0 $0 185 $138,273 4,415 $4,084,867 856 $435,370 797 $7,967,926 471 $60,769 48 $52,438 2,005 $501,017 3,593 $683,586 56 $23,757 278 $25,174 0 $0 0 $0 31 $777,723 0 $0 $17,322,833
Colorado 0 $0 294 $227,335 491 $136,116 841 -- 442 $348,481 0 $0 0 $0 424 $69,749 177 -- 38 -- 52 $11,407 0 $0 0 $0 5 -- 0 $0 $1,379,512
Connecticut 0 $0 210 $22,732 789 $55,353 0 $0 177 $108,151 0 $0 0 $0 477 $13,434 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $394,839
Delaware 0 $0 240 $155,200 0 $0 0 $0 114 $333,000 0 $0 0 $0 117 $247,013 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $982,226
District of Columbia 0 $0 0 $0 704 $305,634 57 $123,648 0 $0 0 $0 0 $0 389 $8,846 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $438,128
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida 0 $0 2,377 $1,009,522 3,030 $118,744 0 $0 23 $44,898 0 $0 29 $4,163 2,983 $288,291 1,155 $891 1,313 $24,294 12,630 $1,495,185 0 $0 0 $0 41 $148,600 3,573 $1,343 $4,793,663
Georgia 0 $0 775 $199,355 434 $26,083 2,140 $78,050 1 $640 0 $0 41 $7,761 1,829 $105,127 0 $0 129 $30,543 0 $0 0 $0 0 $0 0 $0 0 $0 $1,696,498
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii 0 $0 153 $117,559 367 $65,931 0 $0 570 $146,575 0 $0 0 $0 62 $16,544 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $369,216
Idaho 0 $0 53 $11,412 0 $0 0 $0 0 $0 0 $0 3 $540 136 $9,320 0 $0 5 $400 0 $0 0 $0 0 $0 0 $0 0 $0 $21,672
Illinois 0 $0 145 $80,450 2,007 $463,820 0 $0 208 $305,259 193 $104,467 15 $4,429 659 $65,771 64 $149,938 41 $41,864 0 $0 0 $0 0 $0 0 $0 271 $16,317 $1,771,947
Indiana 0 $0 180 $75,889 1,225 $397,769 18 -- 71 $218,949 0 $0 0 $0 0 $0 95 $2,344,444 11 $26,128 1 -- 0 $0 0 $0 3 $100,557 0 $0 $3,519,079
Iowa 0 $0 367 $225,069 818 $149,800 13 $32,763 461 $842,816 0 $0 36 $46,867 789 $198,681 579 $63,251 784 $449,860 1,459 $165,504 0 $0 0 $0 0 $0 0 $0 $2,946,976
Kansas 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 -- $1,135 0 $0 -- $9,833 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $10,968
Kentucky 0 $0 1,078 $237,825 433 $30,681 0 $0 0 $0 0 $0 127 $1,454 1,587 $33,200 0 $0 60 $46,200 0 $0 0 $0 0 $0 0 $0 0 $0 $717,868
Louisiana 0 $0 257 $100,792 1,844 $486,437 84 $5,655 25 $8,392 1 $149 4 $708 0 $0 16 $639 181 $66,803 145 $2,074 0 $0 0 $0 0 $0 0 $0 $2,043,337
Maine 0 $0 0 $0 584 $200,000 0 $0 304 $157,830 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $357,830
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland 0 $0 18 $1,990 454 $128,627 2,747 $1,400,426 723 $2,961,580 4 $1,003 73 $42,603 1,428 $358,283 1,193 $1,398,490 616 $494,409 466 $218,806 0 $0 0 $0 0 $0 0 $0 $8,658,868
Massachusetts 0 $0 0 $0 0 $0 0 $0 595 $377,647 310 $264,575 0 $0 679 $27,468 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $669,690
Michigan 0 $0 172 $65,823 302 $30,036 172 $4,097 0 $0 0 $0 15 $4,289 851 $101,826 0 $0 487 $1,061,025 0 $0 0 $0 0 $0 0 $0 0 $0 $1,710,888
Minnesota 0 $0 900 $368,876 996 $137,971 0 $0 0 $0 49 $8,983 3 $4,549 1,569 $411,568 0 $0 0 $0 91 $143,000 0 $0 0 $0 0 $0 0 $0 $1,183,247
Mississippi 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 185 $18,983 60 $97,803 51 $9,003 81 $17,345 0 $0 0 $0 0 $0 0 $0 $789,880
Missouri 0 $0 1,415 $1,637,911 0 $0 0 $0 0 $0 0 $0 0 $0 466 $125,815 0 $0 0 $0 355 $175,000 0 $0 0 $0 0 $0 0 $0 $1,938,726
Montana 0 $0 72 $69,935 0 $0 0 $0 90 $126,286 0 $0 0 $0 87 $2,400 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $198,621
Nebraska 0 $0 68 $49,016 0 $0 0 $0 42 $21,587 0 $0 0 $0 136 $48,856 27 $48,502 39 $19,182 0 $0 0 $0 0 $0 0 $0 0 $0 $232,143
Nevada 0 $0 163 $84,064 7 $4,278 84 $209,858 171 $305,021 112 $67,494 0 $0 143 $94,865 0 $0 23 $21,845 3,563 $1,151,119 0 $0 0 $0 0 $0 0 $0 $2,285,413
New Hampshire 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $0
New Jersey 0 $0 230 $122,681 208 $21,479 0 $0 89 $73,667 438 $242,986 0 $0 594 $293,915 331 $193,471 484 $155,928 0 $0 0 $0 0 $0 0 $0 0 $0 $1,964,002
New Mexico 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 46 $8,098 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $11,605
New York 0 $0 0 $0 933 -- 2,026 -- 69 -- 0 $0 0 $0 0 $0 0 $0 0 $0 1,685 -- 0 $0 0 $0 0 $0 0 $0 --
North Carolina 0 $0 644 $177,785 527 $62,485 1,198 $55,896 1 $2,181 0 $0 0 $0 673 $68,529 833 $60,829 104 $2,582 3,025 $453,381 0 $0 0 $0 0 $0 0 $0 $912,305
North Dakota 0 $0 56 $24,114 0 $0 0 $0 91 $100,518 0 $0 0 $0 52 $9,255 -- $24,600 -- $15,600 0 $0 0 $0 0 $0 0 $0 0 $0 $274,182
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 1,260 $90,445 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $1,686,771
Oklahoma -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- $0 -- -- -- -- --
Oregon 0 $0 655 $161,041 436 $55,339 0 $0 252 $131,041 0 $0 39 $1,314 360 $55,825 0 $0 1 $172 0 $0 0 $0 0 $0 0 $0 0 $0 $1,835,343
Pennsylvania 0 $0 1,770 $1,025,862 3,951 $1,206,832 714 $670,302 539 $822,613 215 $92,856 100 $31,850 3,268 $692,934 800 $222,213 709 $138,898 0 $0 1 $3,015 0 $0 0 $0 0 $0 $7,614,303
Puerto Rico 0 $0 590 $133,083 24 $34,860 0 $0 3 $17,837 0 $0 0 $0 1,050 $781,115 949 $226,442 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $1,742,147
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island 0 $0 471 $386,088 259 $118,188 128 $458,228 167 $1,700,045 10 $16,829 15 $15,466 301 $171,169 -- $27,263 108 $81,748 0 $0 0 $0 0 $0 0 $0 0 $0 $3,678,204
South Carolina 0 $0 1,397 $309,511 1,662 $91,399 6,233 $850,766 3,772 $139,854 17 $4,336 114 $9,787 3,425 $639,019 2,003 $1,462,959 3,213 $104,900 5,656 $323,203 0 $0 0 $0 2 $22,675 0 $0 $4,257,986
South Dakota 0 $0 135 $68,767 47 $1,162 0 $0 38 $37,022 0 $0 1 $50 99 $12,374 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 1 $25 $143,650
Tennessee 0 $0 180 $194,502 1,914 $413,313 0 $0 450 $342,872 0 $0 0 $0 605 $80,957 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $1,333,857
Texas 0 $0 983 $280,694 1,913 $356,483 996 $479,033 0 $0 0 $0 12 $1,600 2,376 $426,573 1,712 $262,087 194 $215,228 552 $156,151 37 $4,007 0 $0 0 $0 0 $0 $3,298,916
Utah 0 $0 39 $49,405 101 $25,900 34 $15,863 0 $0 0 $0 0 $0 64 $2,194 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $233,056
Vermont 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $130,794
Virgin Islands (U.S.) 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 13 $640 0 $0 0 $0 6 $12,000 0 $0 0 $0 0 $0 0 $0 140 $25,000 $81,280
Virginia 0 $0 695 $495,959 846 $208,189 106 $155,943 144 $432,778 0 $0 13 $33,413 1,689 $812,853 367 $52,499 45 $115,842 53 $1,037 0 $0 0 $0 10 $106,727 0 $0 $4,309,927
Washington 0 $0 0 $0 983 $156,140 0 $0 387 $323,039 0 $0 16 $9,322 956 $66,627 0 $0 53 $17,898 0 $0 0 $0 0 $0 0 $0 0 $0 $573,026
West Virginia 0 $0 470 $21,390 893 $157,600 24 $0 18 $14,747 0 $0 0 $0 578 $25,766 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $219,503
Wisconsin 0 $0 0 $0 1,500 $822,670 0 $0 209 $1,885,197 169 $245,477 0 $0 646 $74,503 0 $0 0 $0 2,407 $265,562 0 $0 0 $0 0 $0 0 $0 $3,324,369
Wyoming 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 10 $550 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 0 $0 $78,550
Total 0 $0 18,201 $8,751,603 38,535 $11,070,267 22,082 $5,079,586 11,452 $22,240,196 2,235 $1,218,700 802 $325,376 38,675 $7,434,291 13,954 $7,329,740 11,577 $3,412,151 33,093 $4,646,584 38 $7,022 0 $0 92 $1,156,282 4,007 $44,728 $100,959,891

Table 20

Scroll or click the table to use your arrow keys

State/Territory Clinical Quality Management Program Administration Other Total
Alabama $342,146 $1,409,690 $0 $1,751,836
Alaska $20,658 $59,627 $0 $80,285
American Samoa -- -- -- --
Arizona $42,963 $1,188,044 $0 $1,231,007
Arkansas $110,643 $598,168 $0 $708,811
California $767,135 $10,851,537 $0 $11,618,672
Colorado $104,579 $998,404 $0 $1,102,983
Connecticut $79,341 $291,494 $0 $370,835
Delaware $90,000 $93,838 $0 $183,838
District of Columbia $171,150 $698,473 $0 $869,623
Federated States of Micronesia -- -- -- --
Florida $801,132 $2,340 $0 $803,472
Georgia $454,127 $1,174,875 $0 $1,629,002
Guam -- -- -- --
Hawaii $0 $628,384 $0 $628,384
Idaho $65,665 $63,436 $0 $129,101
Illinois $65,797 $1,717,449 $0 $1,783,246
Indiana $0 $17,686,811 $0 $17,686,811
Iowa $296,140 $4,335,218 $0 $4,631,358
Kansas $97,085 $159,173 $0 $256,258
Kentucky $0 $403,932 $0 $403,932
Louisiana $88,704 $422,560 $0 $511,264
Maine $110,465 $266,363 $0 $376,828
Marshall Islands -- -- -- --
Maryland $578,928 $1,517,308 $0 $2,096,236
Massachusetts $437,884 $719,379 $0 $1,157,263
Michigan $158,546 $1,014,597 $0 $1,173,143
Minnesota $0 $0 $0 $0
Mississippi $169,802 $35,090 $0 $204,892
Missouri $0 $0 $0 $0
Montana $15,488 $55,451 $0 $70,939
Nebraska $26,692 $328,486 $0 $355,178
Nevada $455,835 $911,700 $0 $1,367,535
New Hampshire $67,848 $210,658 $0 $278,506
New Jersey $334,477 $3,036,272 $0 $3,370,749
New Mexico $88,221 $211,488 $0 $299,709
New York $0 $0 $0 $0
North Carolina $59,587 $3,645,048 $0 $3,704,635
North Dakota $18,490 $109,478 $0 $127,968
Northern Mariana Islands -- -- -- --
Ohio $0 $0 $0 $0
Oklahoma -- -- -- --
Oregon $116,970 $350,263 $0 $467,233
Pennsylvania $17,492 $3,336,738 $0 $3,354,230
Puerto Rico $234,953 $1,489,601 $0 $1,724,554
Republic of Palau -- -- -- --
Rhode Island $246,171 $588,280 $0 $834,451
South Carolina $76,845 $1,414,287 $0 $1,491,132
South Dakota $0 $67,051 $0 $67,051
Tennessee $0 $260,200 $0 $260,200
Texas $534,311 $3,406,309 $0 $3,940,620
Utah $103,640 $952,616 $0 $1,056,256
Vermont $24,238 $61,928 $0 $86,166
Virgin Islands (U.S.) $25,000 $75,954 $0 $100,954
Virginia $145,514 $2,913,173 $0 $3,058,687
Washington $3,020,898 $1,975,060 $0 $4,995,958
West Virginia $12,000 $101,075 $0 $113,075
Wisconsin $115,226 $724,723 $0 $839,949
Wyoming $17,496 $35,214 $0 $52,710
Total $10,810,282 $72,597,243 $0 $83,407,525

Table 21

Scroll or click the table to use your arrow keys

State/Territory 2018 ADAP Expenditures
Prescription Drugs Prescription Dispensing Costs Insurance Premiums Insurance Co-payments and Deductibles Client Outreach Adherence and Monitoring2 Clinical Quality Management Program Administration Other3 Total Expenditures
Alabama $7,399,234 $180,906 $18,987,370 $2,450,596 $0 $0 $0 $1,666,829 $0 $30,684,935
Alaska $540,176 $39,984 $157,416 $155,420 $0 $58,010 $25,491 $88,803 $0 $1,065,300
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona $4,964,476 $826,053 $901,077 $5,703,201 $0 $0 $0 $1,364,099 $0 $13,758,907
Arkansas $4,336,028 $103,118 $0 $1,020,223 $0 $0 $0 $145,261 $0 $5,604,631
California $301,817,223 $254,694 $33,494,046 $36,953,165 $0 $713,758 $0 $24,447,105 $0 $397,679,991
Colorado $5,329,102 $753,990 $5,210,030 $6,236,783 $0 $0 $0 $1,070,000 $0 $18,599,905
Connecticut $5,445,378 $46,393 $1,177,198 $253,400 $0 $0 $0 $175,945 $0 $7,098,314
Delaware $2,015,182 $0 $368,310 $1,084,909 $0 $38,200 $0 $413,027 $0 $3,919,628
District of Columbia $5,509,809 $1,508,306 $990,917 $288,900 $0 $50,000 $222,000 $8,580,852 $0 $17,150,784
Federated States of Micronesia -- -- -- -- -- -- -- -- -- --
Florida $115,924,553 $0 $35,906,852 $21,995,842 $0 $0 $0 $5,465,456 $0 $179,292,703
Georgia $64,279,610 $1,402,776 $4,898,588 $269,855 $0 $0 $0 $1,065,052 $0 $71,915,881
Guam -- -- -- -- -- -- -- -- -- --
Hawaii $672,056 $16,619 $737,027 $633,246 $0 $0 $0 $36,538 $0 $2,095,486
Idaho $6,892,239 $7,680 $0 -- $0 $0 $0 $0 $0 $6,899,919
Illinois $27,974,598 $2,669,140 $13,695,796 $7,842,783 $0 $1,200,906 $0 $1,225,201 $0 $54,608,424
Indiana $8,617,512 $0 -- -- $0 $0 $0 $0 $0 $8,617,512
Iowa $750,032 $65,120 $2,460,680 $927,288 $0 $0 $0 $240,973 $0 $4,444,093
Kansas $10,134,064 $94,332 $1,688,138 $130,854 $0 $0 $0 $210,096 $0 $12,257,484
Kentucky $7,852,344 $450,270 $3,025,198 $2,543,816 $0 $0 $0 $306,000 $0 $14,177,628
Louisiana $3,834,594 $41,790 $16,041,875 $9,086,905 $0 $0 $0 $3,276,989 $0 $32,282,152
Maine $1,264,872 $2,081 $885,616 $961,222 $0 $0 $16,285 $81,725 $11,602 $3,223,403
Marshall Islands -- -- -- -- -- -- -- -- -- --
Maryland $27,415,787 $1,172,562 $13,738,194 $5,309,205 $0 $1,752,975 $433,174 $1,335,182 $0 $51,157,079
Massachusetts $4,540,583 $7,384 $9,054,210 $3,902,805 $0 $1,127,196 $0 $432,589 $0 $19,064,767
Michigan $16,643,272 $97,323 $3,064,255 $14,455,361 $0 $10,777 $1,361 $1,115,126 $0 $35,387,475
Minnesota $6,408,841 $0 $1,011,592 $0 $0 $0 $0 $0 $0 $7,420,433
Mississippi $11,744,927 $103,368 $53,225 $454 $0 $0 $0 $0 $0 $11,901,974
Missouri $37,126,842 $1,935,523 $19,820,820 $891,759 $0 $0 $0 $0 $0 $59,774,944
Montana $812,720 $4,565 $312,421 $342,918 $0 $24,000 $0 $39,573 $0 $1,536,197
Nebraska $2,858,279 $5,511 $3,975,011 $3,752,206 $0 $0 $0 $1,070,715 $0 $11,661,722
Nevada $15,093,757 $112,521 $1,278,863 $2,878,469 $0 $169,346 $0 $0 $0 $19,532,956
New Hampshire $2,227,122 $7,080 $834,341 $795,204 $0 $0 $0 $0 $0 $3,863,747
New Jersey $18,922,623 $0 $3,715,799 $0 $0 $0 $0 $699,025 $0 $23,337,447
New Mexico $335,075 $67,620 $1,754,345 $76,495 $0 $0 $8,354 $106,157 $0 $2,348,046
New York $321,097,086 $1,181,362 $33,026,199 $23,777,099 $572,000 $0 $700,000 $3,828,000 $0 $384,181,746
North Carolina $49,036,558 $2,344,677 $311,542 $5,305,211 $0 $0 $0 $615,088 $0 $57,613,076
North Dakota $1,009,271 $6,881 $187,371 $336,396 $0 $0 $0 $0 $0 $1,539,919
Northern Mariana Islands -- -- -- -- -- -- -- -- -- --
Ohio $22,785,271 $52,012 $4,765,802 $5,008,595 $0 $0 $0 $166,036 $758,466 $33,536,182
Oklahoma $3,996,238 $500,263 $4,243,565 $4,514,361 $206,750 $0 $1,517,615 $1,517,615 $0 $16,496,407
Oregon $12,696,618 $2,510,176 $4,502,460 $1,079,433 $0 $536,000 $12,766 $1,621,000 $0 $22,958,453
Pennsylvania $70,154,810 $436,884 $491,662 $11,218,634 $0 $0 $0 $2,378,181 $0 $84,680,171
Puerto Rico $48,871,655 $38,368 $0 $1,032,771 $0 $247,037 $42,518 $549,233 $0 $50,781,582
Republic of Palau -- -- -- -- -- -- -- -- -- --
Rhode Island $7,259,625 $3,631 $425,125 $0 $0 $0 $0 $0 $0 $7,688,381
South Carolina $16,508,938 $794,538 $8,430,406 $8,227,832 $0 $0 $0 $0 $0 $33,961,714
South Dakota $1,257,200 $200 $1,130,266 $678,783 $0 $0 $132,148 $0 $0 $3,198,597
Tennessee $17,013,767 $41,041 $15,239,838 $8,512,244 $0 $0 $0 $184,817 $0 $40,991,707
Texas $67,824,173 $0 $1,102,357 $1,035,404 $0 $0 $372,405 $1,800,600 $0 $72,134,939
Utah $3,912,832 $111,840 $2,378,085 $2,299,756 $0 $0 $37,368 $190,541 $0 $8,930,422
Vermont $15,719 $6,118 $251,496 $78,382 $0 $0 $18,988 $67,387 $0 $438,090
Virgin Islands (U.S.) $138,707 $13,612 $0 $42,110 $0 $0 $0 $0 $0 $194,429
Virginia $13,695,736 $130,193 $26,743,909 $16,222,915 $0 $904,491 $0 $798,643 $0 $58,495,887
Washington $6,463,098 $27,504 $13,533,030 $6,929,319 $0 $0 $67,156 $1,550,134 $0 $28,570,242
West Virginia $2,493,937 $88,085 $170,800 $721,635 $0 $0 $0 $45,000 $0 $3,519,457
Wisconsin $10,824,886 $164,677 $3,186,510 $3,961,897 $0 $0 $0 $404,590 $0 $18,542,560
Wyoming $541,791 $0 $529,941 $393,743 $0 $0 $0 $6,069 $0 $1,471,544
Total $1,407,280,826 $20,428,771 $319,889,574 $232,319,805 $778,750 $6,832,696 $3,607,629 $70,381,252 $770,068 $2,062,289,371

Table 22

Scroll or click the table to use your arrow keys

State/Territory Ryan White Part B ADAP
Financial Eligibility1 Financial Eligibility1 Calculation Basis
Part B Core Medical Services Part B Support Services Full-Pay Medications ADAP-Funded Insurance Program Gross Income Modified Adjusted Gross Income (MAGI) Net Income Individual Income Household Income Family Income
Alabama 400% FPL 400% FPL 400% FPL 400% FPL Yes No No Yes Yes Yes
Alaska 400% FPL2 400% FPL2 400% FPL 400% FPL Yes No No No No Yes
American Samoa -- -- -- -- -- -- -- -- -- --
Arizona 400% FPL 400% FPL 400% FPL 400% FPL No Yes No No No No
Arkansas 500% FPL 500% FPL 500% FPL 500% FPL Yes No No Yes Yes Yes
California None None 500% FPL 500% FPL No Yes No No No No
Colorado 500% FPL 500% FPL 500% FPL 500% FPL No Yes No No No No
Connecticut 300% FPL 300% FPL 400% FPL 400% FPL No No No No Yes No
Delaware 300% FPL3 300% FPL3 500% FPL 500% FPL No Yes No No No No
District of Columbia 500% FPL 500% FPL 500% FPL 500% FPL Yes No No Yes Yes No
Federated States of Micronesia -- -- -- -- -- -- -- -- -- --
Florida 400% FPL 400% FPL 400% FPL 400% FPL Yes No No Yes Yes Yes
Georgia 400% FPL 400% FPL 400% FPL 400% FPL No Yes No No No No
Guam -- -- -- -- -- -- -- -- -- --
Hawaii 400% FPL 400% FPL 400% FPL 400% FPL Yes No No No No Yes
Idaho 200% FPL 200% FPL 200% FPL 200% FPL Yes No No No No No
Illinois 500% FPL 500% FPL 500% FPL 500% FPL No Yes No No No No
Indiana 300% FPL 300% FPL 300% FPL 300% FPL No Yes No No No No
Iowa 400% FPL 400% FPL 400% FPL 400% FPL Yes No No No Yes No
Kansas 400% FPL 400% FPL 400% FPL 400% FPL Yes No No Yes Yes No
Kentucky 500% FPL 500% FPL 500% FPL 500% FPL Yes No No No No No
Louisiana 400% FPL 400% FPL 400% FPL 400% FPL No Yes No No No No
Maine 300% FPL4 300% FPL 500% FPL 500% FPL Yes No No Yes Yes Yes
Marshall Islands -- -- -- -- -- -- -- -- -- --
Maryland 500% FPL 500% FPL 500% FPL 500% FPL Yes No No No Yes No
Massachusetts 500% FPL 500% FPL 500% FPL 500% FPL Yes No No Yes No No
Michigan 500% FPL 500% FPL 500% FPL 500% FPL Yes No No No Yes No
Minnesota 400% FPL 400% FPL 400% FPL 400% FPL Yes Yes No Yes Yes No
Mississippi 400% FPL 400% FPL 400% FPL 400% FPL Yes Yes No Yes Yes Yes
Missouri 300% FPL 300% FPL 300% FPL 300% FPL Yes No No Yes No Yes
Montana 500% FPL 500% FPL 500% FPL 500% FPL No Yes Yes Yes Yes Yes
Nebraska 300% FPL 300% FPL 300% FPL 300% FPL Yes No No No No No
Nevada 400% FPL 400% FPL 400% FPL 400% FPL No Yes No No No No
New Hampshire 500% FPL 500% FPL 500% FPL 500% FPL Yes No No No Yes No
New Jersey 500% FPL 500% FPL 500% FPL 500% FPL No Yes No No No No
New Mexico 400% FPL 400% FPL 400% FPL 400% FPL Yes No No No Yes No
New York 435% FPL 435% FPL 435% FPL 435% FPL Yes No No No No No
North Carolina 300% FPL 300% FPL 300% FPL 300% FPL No Yes No No No No
North Dakota 400% FPL 400% FPL 400% FPL 500% FPL Yes No No No Yes No
Northern Mariana Islands -- -- -- -- -- -- -- -- -- --
Ohio 300% FPL 300% FPL 300% FPL 300% FPL No Yes No No No No
Oklahoma 400% FPL 400% FPL 400% FPL 400% FPL Yes Yes No No Yes No
Oregon 300% FPL5 300% FPL5 500% FPL 500% FPL Yes No No Yes No Yes
Pennsylvania 500% FPL 500% FPL 500% FPL 500% FPL No No No No Yes No
Puerto Rico 200% FPL 200% FPL 200% FPL 200% FPL No Yes Yes Yes Yes No
Republic of Palau -- -- -- -- -- -- -- -- -- --
Rhode Island 500% FPL 500% FPL 500% FPL 500% FPL No No No No Yes No
South Carolina 550% FPL 550% FPL 550% FPL 550% FPL No Yes No No No No
South Dakota 300% FPL 300% FPL 300% FPL 300% FPL No No No No Yes No
Tennessee 400% FPL 400% FPL 400% FPL 400% FPL Yes No No No No No
Texas 500% FPL 500% FPL 200% FPL 200% FPL Yes Yes No No No Yes
Utah 250% FPL 250% FPL 250% FPL 250% FPL Yes No No No No No
Vermont 500% FPL 500% FPL 500% FPL 500% FPL No Yes No Yes Yes Yes
Virgin Islands (U.S.) 300% FPL 300% FPL 300% FPL 300% FPL Yes No No Yes Yes No
Virginia 500% FPL 500% FPL 500% FPL 500% FPL Yes Yes No No Yes No
Washington 425% FPL6 425% FPL 425% FPL 425% FPL Yes Yes No Yes No Yes
West Virginia 400% FPL 400% FPL 500% FPL 400% FPL8 No Yes No No No No
Wisconsin 500% FPL 500% FPL 300% FPL 300% FPL Yes No No No No Yes
Wyoming 500% FPL7 500% FPL7 500% FPL 500% FPL Yes Yes No No No No
Total 32 24 2 16 24 14

Table 23

Scroll or click the table to use your arrow keys

State/Territory RWHAP Part B Assists with Medicare Part B Drug Cost-Sharing RWHAP Part B Assists with Medicare Part B Medical Cost-Sharing ADAP Pays Premiums ADAP Pays Deductibles ADAP Pays Co-Payments / Co-Insurance (Prescription Only) ADAP Pays Co-Payments / Co-Insurance (Medical Only1) ADAP Requires Advance Tax Credit2 ADAP Requires Tax Return Submission ADAP Assists with Tax Liabilities3 ADAP Assists with Medicaid Co-Payments ADAP Assists with Medicare Part B Drug Cost-Sharing Metal Level of Plans Supported by ADAP
Below 100% FPL 100-138% FPL 139-250% FPL 251-400% FPL 401% FPL and higher Below 100% FPL 100-138% FPL 139-250% FPL 251-400% FPL 401% FPL and higher Below 100% FPL 100-138% FPL 139-250% FPL 251-400% FPL 401% FPL and higher Below 100% FPL 100-138% FPL 139-250% FPL 251-400% FPL 401% FPL and higher 100-138% FPL 139-250% FPL 100-138% FPL 139-250% FPL Bronze Silver Gold Platinum
Alabama Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No N/A N/A No No No No No Yes No
Alaska Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes No No No Yes No No
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes No No
Arkansas Yes Yes No No No No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No N/A N/A N/A N/A No Yes No Yes Yes Yes Yes
California No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes N/A Yes Yes Yes No Yes Yes Yes Yes
Colorado Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No No
Connecticut Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes No No No Yes Yes Yes No
Delaware Yes No No No No No Yes No No No No Yes Yes Yes Yes Yes Yes No No No No Yes N/A N/A N/A N/A Yes Yes No No Yes Yes No
District of Columbia Yes No No No Yes Yes Yes No Yes Yes Yes Yes No No Yes Yes Yes No No No No No Yes Yes Yes Yes No No Yes No Yes Yes Yes
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida No Yes No Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes Yes No No No Yes No No Yes Yes Yes
Georgia Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes No No Yes No Yes
Idaho No No No No No No No Yes Yes No No No Yes Yes No No No No No No No No N/A N/A N/A N/A No No Yes N/A N/A N/A N/A
Illinois Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes N/A Yes Yes No No No Yes No No
Indiana Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No N/A N/A N/A N/A No Yes No No Yes No No
Iowa Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No N/A N/A No Yes No No Yes Yes No
Kansas Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes No Yes Yes No
Kentucky Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes No No Yes Yes Yes Yes Yes Yes Yes
Louisiana No Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No N/A N/A No No Yes Yes Yes Yes Yes
Maine No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes No
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No Yes N/A Yes Yes No No Yes Yes Yes Yes
Massachusetts No No Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes
Michigan Yes Yes No No Yes Yes Yes No No Yes Yes Yes No No Yes Yes Yes No No No No No No Yes N/A Yes Yes No No Yes Yes Yes Yes
Minnesota No Yes Yes Yes Yes Yes No No No Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes Yes Yes No No Yes Yes
Mississippi No No No Yes Yes No No No Yes Yes No No No Yes Yes No No No Yes Yes No No Yes Yes No No No No No No Yes No No
Missouri No No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes No No Yes No No No Yes No No
Montana Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes No
Nebraska No No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No N/A N/A Yes Yes Yes Yes No No No
Nevada Yes Yes No No Yes Yes No No No Yes Yes No Yes Yes Yes Yes No No No No No No No Yes N/A Yes Yes No Yes No Yes Yes No
New Hampshire Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes No No
New Jersey No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes No Yes No No
New Mexico No Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No No Yes Yes No
New York No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No No -- -- -- --
North Carolina Yes Yes No Yes Yes No No Yes Yes Yes No No Yes Yes Yes No No No No No No No Yes Yes No No No No No Yes Yes Yes Yes
North Dakota Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes No Yes Yes No
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes Yes No No Yes Yes No
Oklahoma Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No No Yes Yes No
Oregon Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes
Pennsylvania No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No N/A N/A No No Yes Yes Yes Yes Yes
Puerto Rico No No No No No No No Yes Yes Yes No No Yes Yes Yes No No No No No No No N/A N/A N/A N/A No No No N/A N/A N/A N/A
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island No No Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes No No No No No No No N/A N/A No No No No Yes No No
South Carolina Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes Yes No No No Yes Yes No
South Dakota Yes Yes Yes Yes Yes Yes No Yes Yes Yes No No Yes Yes Yes Yes No Yes Yes Yes Yes No No No N/A N/A No Yes Yes No Yes No No
Tennessee Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No Yes No Yes Yes Yes No
Texas Yes Yes Yes Yes Yes No No Yes No No No No Yes Yes Yes No No Yes Yes Yes No No No No N/A N/A No No No N/A N/A N/A N/A
Utah No Yes Yes Yes Yes No No Yes Yes Yes No No Yes Yes Yes No No Yes Yes Yes No No No No N/A N/A No No Yes No Yes Yes No
Vermont No No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes Yes Yes No Yes No Yes Yes Yes Yes
Virgin Islands (U.S.) Yes No No No No No No No No No No No Yes Yes Yes Yes No Yes Yes Yes Yes No N/A N/A N/A N/A No No No N/A N/A N/A N/A
Virginia No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No Yes Yes No No Yes No No Yes Yes Yes Yes
Washington Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No Yes No No No Yes Yes No
West Virginia Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No No No No Yes Yes No
Wisconsin Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes No Yes Yes Yes Yes No No No No No No Yes Yes Yes Yes Yes No No No Yes No No
Wyoming Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No No No No No No No N/A N/A No Yes No Yes Yes Yes No
Total 33 33 42 45 48 44 24 42 43 45 40 25 50 51 52 47 26 26 27 27 24 11 32 37 23 28 26 25 18 19 45 34 17

Table 24

Scroll or click the table to use your arrow keys

State/Territory Changes in Plan Availability On-Marketplace Access to Single Tablet Regimens on Plan Formularies Client Churn to New Plans or Programs Decreased Availability in Patient Navigators High Co-Payments/Co-Insurance for HIV Medications Mail Order or Specialty Pharmacy Limitations Narrow Provider Networks Restrictions on Special Enrollment Period (SEP) Eligibility Timely Premium Payments to Plans on Behalf of Clients Tax Reconciliation of Advanced Premium Tax Credits Other ADAP Changes in Response to Challenges, 2018
No changes Changed income eligibility for insurance assistance Reduced amount of ADAP insurance purchasing support provided Limited the number of on- or off-ACA Marketplace plans ADAP will support Reduced ADAP formulary Other
Alabama No changes in plan availability Not Challenging N/A Somewhat Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging N/A N/A Yes No No No No No
Alaska Fewer plans offered Somewhat Challenging Somewhat Challenging Not Challenging Somewhat Challenging Very Challenging Not Challenging Not Challenging Somewhat Challenging Somewhat Challenging N/A Yes No No No No No
American Samoa -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Arizona Fewer plans offered Very Challenging Not Challenging N/A Somewhat Challenging Somewhat Challenging Not Challenging Not Challenging Not Challenging Not Challenging N/A Yes No No No No No
Arkansas No changes in plan availability Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Not Challenging Somewhat Challenging N/A N/A N/A No Yes No No No No
California No changes in plan availability Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Not Challenging N/A No No No No No Yes
Colorado Fewer plans offered Somewhat Challenging Somewhat Challenging Not Challenging Not Challenging Very Challenging Somewhat Challenging N/A Very Challenging N/A N/A Yes No No No No No
Connecticut No changes in plan availability Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Very Challenging Not Challenging Not Challenging N/A Yes No No No No No
Delaware No changes in plan availability Not Challenging N/A Very Challenging Not Challenging Very Challenging Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging N/A Yes No No No No No
District of Columbia No changes in plan availability Not Challenging Not Challenging Somewhat Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Very Challenging N/A Yes No No No No No
Federated States of Micronesia -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Florida No changes in plan availability Somewhat Challenging Somewhat Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging N/A Yes No No No No No
Georgia Fewer plans offered Not Challenging Somewhat Challenging N/A Not Challenging Not Challenging Somewhat Challenging N/A Not Challenging N/A N/A Yes No No No No No
Guam -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Hawaii No changes in plan availability Not Challenging Somewhat Challenging N/A Somewhat Challenging Somewhat Challenging Not Challenging Somewhat Challenging Somewhat Challenging Very Challenging N/A Yes No No No No No
Idaho Fewer plans offered Not Challenging Not Challenging Not Challenging Somewhat Challenging Not Challenging N/A Somewhat Challenging N/A N/A N/A Yes No No No No No
Illinois No changes in plan availability Not Challenging Somewhat Challenging Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Not Challenging Not Challenging Somewhat Challenging N/A No No No Yes No No
Indiana No changes in plan availability Somewhat Challenging Somewhat Challenging Very Challenging Very Challenging Very Challenging Very Challenging Somewhat Challenging N/A N/A N/A Yes No No No No No
Iowa Fewer plans offered Not Challenging Somewhat Challenging N/A Not Challenging Very Challenging Very Challenging Not Challenging Somewhat Challenging N/A N/A No No No Yes No No
Kansas No changes in plan availability Not Challenging Not Challenging Somewhat Challenging Somewhat Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging N/A Yes No No No No No
Kentucky No changes in plan availability N/A Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Somewhat Challenging Not Challenging Somewhat Challenging N/A Yes No No No No No
Louisiana No changes in plan availability Not Challenging Very Challenging Not Challenging Not Challenging Somewhat Challenging Not Challenging Not Challenging Not Challenging Very Challenging N/A Yes No No No No No
Maine No changes in plan availability Not Challenging Not Challenging Not Challenging Very Challenging Very Challenging Not Challenging Somewhat Challenging Not Challenging Somewhat Challenging N/A Yes No No No No No
Marshall Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Maryland No changes in plan availability Not Challenging Somewhat Challenging Not Challenging Somewhat Challenging Somewhat Challenging Not Challenging Not Challenging Very Challenging Very Challenging N/A No No No No No Yes
Massachusetts More plans offered Not Challenging Somewhat Challenging Not Challenging Not Challenging Not Challenging Not Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat challenging Yes No No No No No
Michigan Fewer plans offered Not Challenging Somewhat Challenging Very Challenging Somewhat Challenging N/A Not Challenging Not Challenging Very Challenging Not Challenging N/A No No No No No Yes
Minnesota No changes in plan availability Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging N/A Somewhat Challenging Very Challenging N/A Yes No No No No No
Mississippi No changes in plan availability Not Challenging Somewhat Challenging Somewhat Challenging Very Challenging Very Challenging Very Challenging Somewhat Challenging Not Challenging Somewhat Challenging N/A No Yes No No No No
Missouri Fewer plans offered Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging N/A No No No Yes No No
Montana Fewer plans offered Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging Somewhat Challenging Very Challenging Somewhat Challenging Somewhat Challenging N/A No Yes No No No No
Nebraska Fewer plans offered Not Challenging Somewhat Challenging Not Challenging Very Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging N/A No No No Yes No No
Nevada No changes in plan availability Somewhat Challenging Not Challenging Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Not Challenging Not Challenging Very Challenging N/A Yes No No No No No
New Hampshire No changes in plan availability Not Challenging Somewhat Challenging Somewhat Challenging Not Challenging Not Challenging Somewhat Challenging Somewhat Challenging Very Challenging Very Challenging N/A Yes No No No No No
New Jersey Fewer plans offered Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Very Challenging Very Challenging Not Challenging Very Challenging N/A Yes No No No No No
New Mexico No changes in plan availability Not Challenging Somewhat Challenging Very Challenging Not Challenging Very Challenging Not Challenging Very Challenging Very Challenging Somewhat Challenging N/A Yes No No No No No
New York No changes in plan availability Not Challenging Somewhat Challenging Not Challenging Not Challenging Somewhat Challenging Not Challenging Not Challenging Somewhat Challenging Somewhat Challenging N/A Yes No No No No No
North Carolina Fewer plans offered Not Challenging Not Challenging N/A Very Challenging Not Challenging Not Challenging Very Challenging Somewhat Challenging Not Challenging N/A Yes No No No No No
North Dakota Fewer plans offered Not Challenging Very Challenging Very Challenging Somewhat Challenging Somewhat Challenging Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging N/A No Yes No No No No
Northern Mariana Islands -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Ohio Fewer plans offered Very Challenging Very Challenging Somewhat Challenging Very Challenging Very Challenging Very Challenging Very Challenging Very Challenging Very Challenging Very Challenging Yes No No No No No
Oklahoma No changes in plan availability Somewhat Challenging Very Challenging Very Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging Somewhat Challenging Very Challenging Yes No No No No No
Oregon Fewer plans offered Not Challenging Very Challenging N/A Not Challenging Very Challenging Very Challenging Somewhat Challenging Very Challenging Very Challenging N/A Yes No No No No No
Pennsylvania No changes in plan availability Not Challenging Somewhat Challenging Not Challenging Not Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging N/A N/A Yes No No No No No
Puerto Rico No changes in plan availability N/A N/A N/A Somewhat Challenging N/A N/A N/A N/A N/A N/A Yes No No No No No
Republic of Palau -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- -- --
Rhode Island No changes in plan availability Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging N/A Yes No No No No No
South Carolina No changes in plan availability Somewhat Challenging Somewhat Challenging N/A Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging N/A Yes No No No No No
South Dakota No changes in plan availability Not Challenging Very Challenging Somewhat Challenging Very Challenging Very Challenging Very Challenging Very Challenging Somewhat Challenging Somewhat Challenging N/A Yes No No No No No
Tennessee More plans offered Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging N/A Yes No No No No No
Texas No changes in plan availability Not Challenging Not Challenging Not Challenging Not Challenging Somewhat Challenging Not Challenging N/A Somewhat Challenging N/A N/A Yes No No No No No
Utah Fewer plans offered Not Challenging Somewhat Challenging N/A Somewhat Challenging Very Challenging Very Challenging Somewhat Challenging Somewhat Challenging N/A N/A Yes No No No No No
Vermont No changes in plan availability Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging N/A Yes No No No No No
Virgin Islands (U.S.) No changes in plan availability Not Challenging Somewhat Challenging Somewhat Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging Not Challenging N/A Yes No No No No No
Virginia Fewer plans offered Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging Not Challenging Very Challenging Very Challenging N/A No No No No No Yes
Washington Fewer plans offered Not Challenging Not Challenging Not Challenging Somewhat Challenging Not Challenging Somewhat Challenging Not Challenging Not Challenging Not Challenging N/A Yes No No No No No
West Virginia No changes in plan availability Not Challenging Very Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Not Challenging Very Challenging Very Challenging Somewhat Challenging N/A Yes No No No No No
Wisconsin No changes in plan availability Not Challenging Somewhat Challenging Somewhat Challenging Somewhat Challenging Very Challenging Somewhat Challenging Very Challenging Somewhat Challenging Very Challenging N/A Yes No No No No No
Wyoming Fewer plans offered Not Challenging N/A Not Challenging Somewhat Challenging Not Challenging Somewhat Challenging Very Challenging Not Challenging N/A N/A Yes No No No No No
Total 21 13 35 24 33 36 27 32 32 32 3 41 4 0 4 0 4

  View Appendix

HIV Antiretroviral and Opportunistic Infection Medications

Tables

  1. 1

    Total RWHAP Part B Budget and ADAP Budget, FY2019

  2. 2

    Total RWHAP Part B Budget, Including ADAP, by State and by Source, FY2019

  3. 3

    Total RWHAP Part B and ADAP Budget, FY2018 and FY2019

  4. 4

    Major FY2019 RWHAP Part B Budget Categories Compared with FY2018

  5. 5

    ADAP Cost Recovery from Other Payers (Excluding Drug Rebates and Program Income), Calendar Year 2018

  6. 6

    EHE Jurisdictions

  7. 7

    Total RWHAP Part B and ADAP Clients Enrolled and Served, Calendar Year 2018

  8. 8

    RWHAP Part B and ADAP Clients by Viral Load, Enrolled During 12-Month Period, Calendar Year 2018

  9. 9

    RWHAP Part B and ADAP Clients Served, by Race, Calendar Year 2018

  10. 10

    RWHAP Part B and ADAP Clients Served, by Ethnicity, Calendar Year 2018

  11. 11

    RWHAP Part B and ADAP Clients Served, by Age, Calendar Year 2018

  12. 12

    RWHAP Part B and ADAP Clients Served, by Gender, Calendar Year 2018

  13. 13

    RWHAP Part B and ADAP Clients Served, by Income Level, Calendar Year 2018

  14. 14

    ADAP Clients Served by Other Payers, Calendar Year 2018

  15. 15

    ADAP Funds Used Through Insurance Purchasing and Continuation, 2018

  16. 16

    ADAP Clients Served Through Insurance Purchasing and Continuation, 2018

  17. 17

    ADAP Clients Served by Medicare by Medicare Coverage Type, Calendar Year 2018

  18. 18

    Total RWHAP Part B Core Medical Program Expenditures and Utilization, 2018

  19. 19

    Total RWHAP Part B Support Services Program Expenditures and Utilization, 2018

  20. 20

    Other RWHAP Part B Program Expenditures, 2018

  21. 21

    Total ADAP Program Expenditures, 2018

  22. 22

    RWHAP Part B and ADAP Client Financial Eligibility Requirements, as of January 1, 2018

  23. 23

    ADAP Policies Related to Insurance Purchasing as of January 1, 2018

  24. 24

    Challenges Faced by ADAPs, Calendar Year 2018 vs. Calendar Year 2017

Charts for each major finding, tables, with data provided by state, and a complete ADAP glossary are included in the full report. State-level data from this report are available on the NASTAD website.

A glossary of key ADAP terms can be found on the NASTAD website.