Uninterrupted access to Human Immunodeficiency Virus (HIV) treatment is key to achieving long-term viral suppression for people with HIV (PWH). Viral suppression is important for PWH to achieve optimal individual health outcomes and prevent HIV transmission. The AIDS Drug Assistance Program (ADAP) is a state-administered program authorized under Part B of the federal Ryan White HIV/AIDS Treatment Extension Act of 2009. To help reduce the stigma often associated with HIV services, Virginia ADAP changed its name to the Virginia Medication Assistance Program (VA MAP). The program provides access to HIV medications for low-income people with HIV who have limited or no health coverage, either directly or through the purchase of health insurance coverage on the federal Marketplace. The Ryan White HIV/AIDS Treatment Extension Act of 2009 requires that VA MAP serve as the payer of last resort. The Health Resources and Services Administration (HRSA) provides federal oversight of Ryan White Part B and VA MAP.

Before Virginia Medicaid expansion in 2019, VA MAP determined that approximately 4,000 clients were Medicaid eligible. From September 1, 2019 to August 31, 2021, VA MAP dis-enrolled 3,100 clients who transitioned to Medicaid and began using their pharmacy benefits. Medicaid is beneficial to clients since it provides comprehensive coverage for their health and medication needs beyond HIV-related services. Insurance coverage for clients during the COVID-19 pandemic served as an additional safety net for PWH. COVID-19 contributed to job losses, decreased income, and threats to housing stability and food security. Decreased income during the pandemic led to more VA MAP clients being eligible for Medicaid, even though VA MAP previously assisted them with cost shares associated with their employer-based insurance. During the COVID-19 declared Public Health Emergency (PHE), Medicaid maintained continuous coverage for clients even if their circumstances would have otherwise made them ineligible. The US Department of Health and Human Services renewed the PHE under the Public Health Service Act on January 11, 2023. On January 30, 2023 the Biden administration announced its intent to end the national emergency and public health emergency declarations on May 11, related to the COVID-19 pandemic.

The Department of Medical Assistance Services (DMAS) will begin to review eligibility for every Medicaid enrollee within 60 days after the end of the PHE. This may result in an increased demand for VA MAP services.