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ADAP projected needs fall slightly; advocates urge reinvestment of rebate surplus into PrEP, testing and workforce
Summary
The Office of AIDS estimated ADAP budget authority needs of $444M for 2025–26 and $443.7M for 2026–27; advocates told the committee a projected ADAP rebate surplus could be reinvested in PrEP, testing, rapid‑connection to care and disease‑intervention workforce.
Joseph Grama, branch chief of the ADAP branch in the Office of AIDS, told the subcommittee the ADAP budget‑authority need for 2025–26 is estimated at $444,000,000, an 8.8% decrease from the 2025 Budget Act driven by lower medication and premium expenditures and caseload refinements. He projected the 2026–27 need at $443.7 million and said the reduction largely reflected the expiration of one‑time investments.
Grama said $400,000,000 of previously lent ADAP funds are anticipated to be repaid in fiscal year 2027–28 and the remaining $500,000,000 expected in 2028–29.
Public commenters from the HIV advocacy community pressed for reinvesting an ADAP rebate surplus into underfunded strategies. "The ADAP rebate fund ... will run a $203,000,000 surplus next fiscal year," Jonathan Froxweig of the San Francisco AIDS Foundation told the panel, urging the legislature to use roughly $143 million of that surplus for PrEP, low‑barrier testing and rapid connection to care.
Other speakers from APLA Health, Equality California and local health‑department coalitions echoed calls to use rebate funds to shore up disease‑intervention specialists, expand testing and prevent layoffs that would jeopardize HIV, STI and HCV work. The committee did not take a vote; members and advocates said they would continue negotiations as the budget process unfolds.
