Beginning next year, the federal government will require Medicaid enrollees who qualified through the Affordable Care Act’s expansion program and are living near the poverty level to document that they’re either working, in school or participating in community service to continue receiving coverage. More than a million Americans live with HIV, and about 40% of those adults are currently enrolled in Medicaid.
Exemptions and Concerns
The law created exemptions for groups of people such as caregivers, pregnant women, people who are disabled or those with substance use or mental health disorders. Additionally, there is an exemption for people with serious or complex medical conditions, but there was no specific definition of those medical conditions, with Congress leaving it to law implementers to decide who qualifies.
According to estimates from KFF, more than 145,000 people living with HIV would lose insurance coverage if they don’t qualify for one of the exemptions. The loss of coverage would not just interrupt many patients’ treatment regimens but put their lives in danger, and would greatly increase the risk of new HIV transmissions, resulting in far greater public health spending in the long run.
Progress Under Threat
People living with HIV require access to antiretroviral medications, skilled providers, case managers and services to support treatment adherence — all of which are provided by Medicaid. Domestically, new HIV cases have been dropping, with infections declining by 12% between 2018 and 2022. However, tens of thousands are still diagnosed with HIV annually. Losing Medicaid coverage for a substantial portion of the HIV population could severely undermine the progress made against HIV.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://elizabethton.com/2026/04/23/new-medicaid-work-requirements-threaten-to-undermine-hiv-progress/