State funding cuts from the Virginia Department of Health have sharply reduced support for a program that makes wraparound services accessible for vulnerable residents with HIV. The cuts have left hundreds of patients in Southwest and Southside Virginia with fewer resources.
The reduction in funding is tied to the way the state pays for HIV medications. For grant year 2026, Virginia received less money in rebates from the pharmaceutical company than in previous years. These cuts have been directed to the Ryan White Part B program, which covers core medical and support services such as primary care, dental, mental health and housing.
The Health Department has not responded to queries from Cardinal News about how much money was lost or why.
The Ryan White HIV/AIDS Program, enacted by Congress in 1990, supports access to low-cost outpatient HIV care, prescriptions and support services to those without health insurance. Part B, covering core medical services, is the payer of last resort, meaning it only pays for services after all other available funding has been used or ruled out.
Funding for the program has been cut several times over the last year.
In April 2025, the Trump administration cut the national program’s overall funding by about $525 million, or 20%, according to the HIV + HEP Policy Institute. Around the same time, rebate issues emerged between the state Health Department and the company that supplies HIV medications. In response, the state redirected its remaining funds to prioritize medication assistance and ensure continued access to affordable HIV treatment.
These cuts strained many Part B providers across the state. The Council of Community Services, a Roanoke-based nonprofit that serves unhoused and HIV-positive clients, became the only provider of Part B services in the Southwest and Southside regions. The nonprofit was also dealing with the funding reductions. The Part B budget dropped $2.5 million in 2024 to $1.5 million in 2025, said Todd Rothrock, the director of medical services at the nonprofit.
In mid-November 2025, the Health Department informed the council of another funding reduction, further cutting the budget to $1.2 million. The council significantly reduced its staff, shrinking case management capacity for over 600 low-income and unhoused patients who rely on wraparound care to stay engaged in treatment and maintain their health.
During a public hearing hosted by the Virginia Department of Health on Wednesday, agency representatives confirmed that the most recent reductions originated at the state level. Allison Green, senior program advisor to Ryan White Part B, said the cuts stem from rebate issues between the department and the company that supplies HIV antiviral medications.
An ongoing issue with the pharmaceutical company
The Health Department did not provide any details regarding the rebate issue with the pharmaceutical company, nor did it answer questions about how much money was lost.
Generally, when a buyer purchases a drug from the manufacturer, the buyer pays the full price upfront, according to information on the federal Medicaid website. Federal law requires drug manufacturers that want their drugs covered under Medicaid to enter into a drug rebate agreement. These rebates are eventually sent from the pharmaceutical company back to the buyer. The amount of rebate is set in statute and varies by drug.
Additionally, most states negotiate with manufacturers for supplemental rebates, according to KFF. These additional rebates are negotiated privately.
Rebate issues can arise from a variety of factors such as legal or compliance issues, delays or discrepancies over data reporting, contract disputes or changes in drug pricing.
State Health Department representatives declined to comment on the reason for the reduction in rebates during the public hearing. The department did not respond to questions from Cardinal News about any future funding cuts.
“It is an ongoing situation that we have with a company. It’s not as a result of the federal funding itself,” Green said during the public hearing. “It is a situation that has indeed caused the rebates to be reduced drastically because of the resolution that is ongoing.”
600 clients divided among 3 case managers
The council reduced its case management staff from 12 providers to three in December, according to Rothrock. The remaining staff are medical case managers, meaning they help people access doctor appointments and medication.
CCS closed its office in Danville, with one provider working remotely. The Marion office also closed in December; one case manager is serving that region remotely. The third case manager is based in Roanoke.
Medical case managers work directly with medication access and medication adherence, Rothrock said. They make sure clients are able to get to their medical appointments and help them fill prescriptions. They also help translate medical notes into plain language to help individuals understand test results and the importance of taking medications.
The council no longer has any non-medical case managers, who help clients access wraparound services such as housing and food. They also help them enroll in Medicaid or identify other options for health insurance. They support clients in a therapeutic way, talking about their diagnosis and connecting them to mental health services.
“We do all of those things so we can create a more stable situation for the individual to then be able to have that positive response to their HIV medication,” Rothrock said.
Because of the stigma surrounding HIV, the case managers are sometimes the only people who know about the client’s diagnosis.
Now, 600 clients are divided among the three remaining medical case managers. Regular case management will mostly be lost, though the medical staff will do their best to support the clients, Rothrock said. Since the April closures last year, the council has taken on about 100 more patients.
Typically, case managers plan to check in with clients once a month. Some high-risk clients — such as those who have been newly diagnosed or just out of incarceration — may check in every day.
The council works hard to intervene with these individuals to keep them from getting sicker or falling back into bad habits.
“Now we’re really having to pull that back because there’s no time. Or say, OK, we just really need to focus on the highest risk population,” Rothrock said.
Budget attempts to backfill the program
Del. Wendell Walker, R-Lynchburg, introduced a budget amendment to backfill gaps in the Ryan White Part B program. The amendment calls for $5 million in 2026 to support access to wraparound services for vulnerable HIV patients.
He expects the amendment will go to the appropriations committee soon and could trigger a budget battle.
“We’re going to keep pushing it,” he said. “These are critical services. Even if it gets reduced, something is better than nothing.”
Del. Rodney Willett, D-Henrico County, also proposed a budget amendment of $6 million to backfill the program.
“There is one place for these AIDS patients to get help through these Ryan White programs. It’s not like they’ve got one or two or three other options to go to. So when there was a disruption to that funding, literally lives were at stake,” Willett said.
This amendment applies only to 2026. Willett hopes that the funding issues at the state health department will be resolved in the following year.