Beginning next year, the federal government will require Medicaid enrollees who qualified through the Affordable Care Act’s expansion program to document that they are working, in school, or participating in community service to maintain coverage. The new work requirement, however, includes exemptions for certain groups, and a critical gap threatens people living with HIV.
The law exempts caregivers, pregnant women, people who are disabled, and those with substance use or mental health disorders. It also exempts people with “serious or complex medical conditions”—but Congress left the specific definition to federal administrators and potentially individual states if federal guidance is not provided.
About 40% of the more than one million Americans living with HIV are currently enrolled in Medicaid. According to estimates from the Kaiser Family Foundation, over 145,000 people living with HIV would lose insurance coverage if they do not qualify for one of the work requirement exemptions. Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, argues that HIV should clearly qualify for exemption: “HIV is a lifelong, serious and complex medical condition. People may be living longer and managing their disease better today — but only if they have access to antiretroviral medications, skilled providers, case managers, and services to support treatment adherence.”
The stakes are high for public health. Losing coverage would interrupt treatment regimens and put patients’ lives in danger, while also greatly increasing the risk of new HIV transmissions and resulting in far greater public health spending long-term. Domestically, new infections have been declining—dropping 12% between 2018 and 2022—but tens of thousands are still diagnosed annually, underscoring the need to maintain treatment access.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://iniusa.org/stories/new-medicaid-work-requirements-threaten-to-undermine-progress-on-hiv,3312