The Arkansas AIDS drug assistance program (AR ADAP) and a Ryan White CARE program have slashed their annual income eligibility threshold to $21,660, leaving many positive people in the state scrambling for options to pay for expensive treatments, reports the Arkansas Times. Previously, the ADAP and Ryan White programs accepted applicants whose yearly income was up to 500 percent of the federal poverty level—$51,050 or less.

According to the article, 203 recipients of Ryan White and 49 from ADAP will be removed from the programs based on new guidelines.

Health department officials said this scaling back was necessary to focus on those in the most desperate financial situations. However, a shrinking budget and a spike in those seeking assistance were other contributing factors. Recipients have until December 31 to make other arrangements for care.

Many will have to look to pharmaceutical drug programs for assistance. But this could be a discouraging process for some, said James Phillips, infectious disease chief, who worries patients will end up discontinuing their drug regimens.

“Continuity is very important in decreasing the development of resistance,” Phillips said. “Once an individual develops a resistance to the first set of drugs that they are started on, then you try to recoup and progress onto a different regimen. It almost always is a more expensive regimen.”

ADAP has provided drug assistance to people living with HIV/AIDS in Arkansas since 1990.