30573350, 64DER26-1 - Florida Administrative Rules, Law, Code, Register

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Notice: 30573350

Notice of Emergency Rule

Department:

DEPARTMENT OF HEALTH

Division:

Division of Disease Control

Overview

RULE:

64DER26-1

Definitions

SPECIFIC REASONS FOR FINDING AN IMMEDIATE DANGER TO THE PUBLIC HEALTH, SAFETY OR WELFARE:

The Ryan White Grant program is a voluntary federal program that issues grant monies to states for HIV/AIDS prevention and treatment.  There is no state statute compelling the Department to participate in that grant program nor is there any federal requirement that the Department participate.  The Department has, however, applied for the grant as part of the Department’s broad authority to implement programs and policies that provide for the prevention and control of communicable diseases.  See § 381.0011, Fla. Stat.  Specifically, the Department has broad authority and discretion to determine which programs, if any, to implement (and the contours of those programs) for the prevention and control of human immunodeficiency virus infection and acquired immune deficiency syndrome. See § 381.003, Fla. Stat.  
That authority and discretion have been exercised, in part, by applying for and administering a federal grant program to provide certain medications to low-income individuals with HIV/AIDS.  The program, as implemented by the Department includes, among other things, direct dispense medication and the payment of insurance premiums for full healthcare coverage (not just limited to medication) to certain individuals who qualify under the Department’s program parameters.  The health insurance has been acquired and provided through the Affordable Care Act (ACA) marketplace exchange.   
The federal government implemented enhanced subsidies in 2021 that helped maintain ACA insurance premiums at a certain level.  The federal government ended those enhanced subsidies for ACA insurance premiums in 2025.  As a result, ACA insurance costs have increased by almost double.  Concurrently, the federal government has not increased Ryan White Grant funding to offset the ACA insurance cost increases. 
The Department is allotted a finite sum of money under the Ryan White Grant and a much smaller amount of state dollars is allocated yearly by the legislature for this program.  The federal government requires that States receiving the grant provide direct dispense medication with the grant money, but it does not require use of grant money for ACA insurance.
If current program eligibility and program parameters are not adjusted, the Department will have insufficient funds such that it could have to terminate all services to all eligible persons.  Put more simply, the Department has not been allocated enough money federally or at the state level to continue with the program as-is for the remainder of the calendar year.  Approximately 32,000 persons with HIV/AIDS could lose access to some or all medications as a result.  
The Department concludes that such a situation would create an immediate danger to the public health, safety, or welfare. Without any continued medication, the viral loads in 32,000 infected persons could elevate and could facilitate transmission of HIV within the state.  Accordingly, in an attempt to mitigate that situation, it is necessary to ensure the greatest number of people can receive some direct dispense medication within the constraints of available funding, which is the baseline federal requirement under the grant.  Accordingly, the Department must immediately update the program parameters to ensure access to HIV/AIDS Patient Care Programs by those most in financial need of medication.  While not all currently eligible persons may receive medication, and while the insurance component of the program will be terminated to achieve these goals, the continuance of direct dispense medication under revised parameters will continue to comply with federal grant requirements,  will provide the greatest medical benefit to those in greatest financial need, and will mitigate risk of transmission – all within the constraints of allocated funding.

REASON FOR CONCLUDING THAT THE PROCEDURE IS FAIR UNDER THE CIRCUMSTANCES:

The program parameters are set by existing rules.  The federal enhanced subsidies for ACA insurance ended late 2025.  The Department is engaged in non-emergency rulemaking procedures to ensure public participation in the rulemaking process.  However, that legislatively established process will take too long to immediately address the consequences from the lack of adequate funding.  There is no other feasible mechanism under the Administrative Procedure Act to revise the existing program parameters other than an emergency rule that modifies existing rules.

SUMMARY:

The emergency rule will update definitions of “HIV/AIDS Patient Care Programs,” “low income,” “federal poverty level,” and other defined terms.

THE PERSON TO BE CONTACTED REGARDING THE EMERGENCY RULE IS:

Amber Pepe at amber.pepe@flhealth.gov or (850)901-6953.

PRINT PUBLISH DATE:

2/26/2026 Vol. 52/39

OVERSIGHT COMMITTEE:

Joint Administrative Procedures Committee
Florida Administrative Law Central Online Network (F.A.L.C.O.N.)

RELATED COURT CASES:

Division of Administrative Hearings

FEDERAL eRULEMAKING
WEB PORTAL:

Regulations.gov

HOW TO LINK TO
THIS NOTICE:

http://flrules.org/gateway/ruleno.asp?id=64DER26-1&PDate=2/26/2026&Section=4

REFERENCE MATERIALS:

Ref-14754 64D-4.002 County Income Limits 2022_no links
Ref-14755 64D-4.002 Federal Poverty Level _01.21.2022

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