ADAP costing analysis
We compared two futures: one where ADAP funding stays the same, and one where ADAP ends in January 2026 and does not return through 2035. Ending ADAP saves money on the program itself, but it also leads to more new HIV cases, and those people will need HIV care. We added up both sides to see how they compare.
We modeled two scenarios from 2026 to 2035:
We projected new HIV infections and diagnoses under each scenario. The difference between the two represents the additional cases associated with ending ADAP.
We estimated the average cost of keeping a person with HIV in care and applied that cost to these additional cases over time.
We added those care costs through 2035 and compared them with the savings from eliminating ADAP.
All costs are in 2026 US dollars, discounted at 3% per year.
Modeled result through 2035
For every $1 saved by ending ADAP, about $1.71 comes back as new HIV care costs.
Eliminating ADAP in 2026 would save about $6.6B in program spending through 2035, but would add about $11.2B in HIV care for people newly infected. That is about $4.7B more spent.
ADAP program spending
Care for people newly infected
More spent
Without ADAP, many people lose steady access to HIV medicine, and fewer keep their virus under control. By 2035, that means about 143,000 more HIV infections and about 106,000 more diagnoses.
Care costs exceed ADAP savings in 81 of every 100 modeled results. The likely range is $4.9B in net savings to $16.1B in net costs. This covers 30 states and Washington, DC.
The scenario begins in January 2026.
Loss of medication access changes HIV outcomes.
143,000 additional infections are projected.
Medicine and routine care create costs over time.
Hospital stays and illnesses caused by weakened immunity are not included here.
Jurisdiction results
30 states + Washington, DC
In the 30 states and Washington, DC included in the analysis, ending ADAP is projected to result in about 143,000 additional HIV infections through 2035. It would save about $6.6B in ADAP spending and add about $11.2B in new HIV care costs.
That is about $1.71 in new HIV care costs for every $1 saved. New care costs are larger than ADAP savings by 2035.
New HIV care costs are larger than ADAP savings in 81 of every 100 modeled results.
Cumulative median costs and savings for the 30 states and Washington, DC included in the analysis.
Loading the annual comparison…
Across the modeled jurisdictions, states where ADAP supports a larger share of people with controlled HIV, and less urban states, tended to see larger net costs.
Budget context
The savings occur in the ADAP budget. New costs could fall on Medicaid, Medicare, private insurers, hospitals, and other parts of the Ryan White program. In other words, savings in one budget can move costs to others. This analysis does not estimate each payer’s share.
What is not counted
We counted only HIV medicine and routine care for people newly infected, through 2035. We did not count care for current ADAP clients who lose coverage, hospital stays, deaths, lost work or productivity, or any costs after 2035. The full economic cost could therefore be higher.
See detailed methods, assumptions, uncertainty, and results for each modeled jurisdiction.
The likely range reflects variation across model simulations and cost assumptions. Dollar amounts are in 2026 US dollars and discounted at 3% per year. The aggregate covers 31 modeled jurisdictions and is not an estimate for all US jurisdictions.