The Virginia (VA) Acquired Immunodeficiency Syndrome (AIDS) Drug Assistance Program (ADAP) provides access to life-saving medications for the treatment of HIV and related illnesses for low-income clients with no other access to treatment.  The Virginia Department of Health (VDH) had 6,701 clients enrolled in ADAP as of March 2018.  This is an increase of 342 clients over the past 12-month period.  Clients who adhere to treatment for Human Immunodeficiency Virus (HIV) can achieve long-term viral suppression, which results in the best individual health outcomes and prevents sexual transmission of HIV, reducing new infections.  VA ADAP uses the most cost-effective strategy for service provision by purchasing health insurance for the majority of enrolled clients.  Providing medications through insurance is key to VA ADAP sustainability and prevents waiting lists for clients needing services.  Despite changes in the Affordable Care Act (ACA) Marketplace and a shortened enrollment period, VA ADAP had over 75% of clients enrolled in insurance programs as of March 2018.  During the 2018 General Assembly session, the Virginia General Assembly enacted legislation to implement Medicaid expansion on January 1, 2019, which will provide health services access to nearly 61% of currently enrolled VA ADAP clients.  VDH is committed to continued program transformation to make optimal use of available resources to support improvements in health outcomes for persons living with HIV and in reducing HIV transmission in the Commonwealth.