Retaliation? Provider loses $3.5M in state contracts after fighting HIV cuts

The Department of Health (DOH) notified the AIDS Healthcare Foundation that it would not renew five of its contracts to test and treat people with HIV and stop the spread of the sexually transmitted infection (STI).

The AHF, which filed a number of unsuccessful legal challenges in administrative and circuit court to stop the Gov. Ron DeSantis administration from reducing eligibility for the AIDS Drug Assistance Program, as well as the medications clients can access, said the contracts are being cancelled in retaliation for its legal actions and support of rallies across the state calling attention to the cuts.

The contracts ran the gamut — from helping with housing for people living with HIV and AIDS, to navigating people through what can be complex health care systems, to operating a wellness center that provides free care for STIs.

“It was vicious, at best,” AHF Southern Bureau Chief Tracy Jones told the Phoenix in an exclusive interview. “This is so far out of bounds. I can tell you for myself, as the southern bureau chief, I think this is kind of gutter low.”

The AHF is the largest AIDS organization in the world. Jones said it will challenge the notices of nonrenewals. And, she said, it will continue to provide services in Broward, Miami-Dade and Pinellas counties, as well as Fort Myers in Lee County.

“So, we will fight this one with the same vigor that we fought the Department of Health to eliminate people’s drug coverage; we’re going to fight it again,” Jones said, adding that the nonrenewal notifications didn’t include any “grounds” for them.

Jones was insistent that the state is punishing the AHF for challenging the DeSantis administration as it moved to eliminate thousands of people from the program, citing a purported $120 million shortfall.

“I mean, it’s a violation of our freedom of speech, which we’re entitled to, and it is a violation of the rights of folks in Florida. You know, overall, you can’t just take away their ability to have the services they need that these contracts fulfill because you’re mad,” she said.

The Phoenix asked the DOH to comment on AHF’s allegations that the Department is exacting revenge against the organization and whether the services will be terminated or offered by a different provider.

The DOH did not respond.

The program, called ADAP, is funded with federal Ryan White HIV/AIDS Program grants. States receive federal grants and drug rebate money — the latter making up the bulk of state program budgets — to, among other things, help pay for medications and support community groups and specific populations, such as women and children.

Alleging that $120 million deficit in the program, the DeSantis administration reduced eligibility for ADAP participation to 130% of the federal poverty level, or about $20,748 annually. It also eliminated access to Biktarvy and trimmed back the number of patients who could use Descovy. Biktarvy is the top antiretroviral medicine prescribed for HIV patients in the state and the nation.

Jones said the five contracts were in various stages of negotiation and that one of them, a $255,260 contract for Pinellas County, had been signed when notice came that they would not be renewed.

The AHF had been working with the DOH on the contract renewals for weeks, she said, when it started to hear in March that the DeSantis administration wasn’t going to renew the agreements. The rumors started to fly, she said, as the AHF helped negotiate a plan to pump $31 million into the ADAP program and to temporarily restore, through June 30, some of the reductions the DeSantis administration had made.

“There was lots of information flying around that led us — that told us, not led us — to believe that Gov. DeSantis no longer was going to honor any of the contracts for AIDS Healthcare Foundation,” she said.

When pressed about where the AHF was getting its information, Jones said it was from the DOH itself.

The Miami Dade County Health Department notified the AHF via email March 31 that it “would not be moving forward” with two new contracts for HIV and AIDS testing and treatment in the county. The contracts expired March 31 and new ones were set to take effect April 1, according to a chart compiled by the AHF. Combined, they were worth $63,362.48.

The March 31 email also told the AHF that the existing agreement for the Housing Opportunities for Persons with AIDS Program (HOPWA) would “expire as scheduled.”

The AHF said the HOPWA contract was valued at $830,544.

The DOH also said it would not renew a $2 million-plus contract in Broward County. The AHF contracts with the Broward County Health Department to operate an STI Testing & Treatment Center.

“The amount of people that will be harmed solely in Broward County because of our relationship with Broward County Health to provide these services for Broward County and then to have them pull the rug out from under patients who are in need of those services that the county is tasked to provide is just kind of head twisting,” Jones said.

Fort Lauderdale activist Michael Emanuel Rajner chastised the DOH for what he called another attack on ADAP clients.

“Just when the Florida Legislature stepped forward with stopgap funding, the DOH is once again disrupting a system of care where clients are left trying to figure out how to navigate another problem because DOH leadership is more focused on being vindictive rather than effectively meeting the health needs of Floridians,” he told the Phoenix.

Esteban Wood, AHF’s director of advocacy, legislative affairs, and community engagement, also questioned the wisdom of canceling a contract in Broward County, where HIV infections have ranked among the highest in the nation.

Wood said the AHF has been instrumental in helping to lower the new HIV infection rate in the county from 40.8 per 100,000 people in 2017 to 19.2 new infections per 100,000 people in 2021.

He wonders, though, about the cumulative effect of the state’s decisions to reduce ADAP income eligibility to people earning $20,748 or less annually. limiting access to life-saving drugs, and not renewing AHF contracts.

“Are we trying to kill people? Is that the point?” Wood said.

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Reporting by Christine Sexton. Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: [email protected].