By Rachel Klein (The AIDS Institute) and Joe Huang-Racalto (NMAC).

Congress is once again proposing to cut Medicaid—not by reducing benefits outright, but by adding harmful work reporting requirements for so-called “able-bodied adults.” These requirements would disproportionately affect people living with HIV, especially those enrolled through Medicaid expansion programs. In fact, more than half of all adults with HIV on Medicaid in expansion states rely on that very coverage.

We know from past experience that work reporting requirements don’t lead to increased employment—they lead to lost health coverage. The Congressional Budget Office warned lawmakers in 2023 that such a policy would cause millions to lose Medicaid, drive up administrative costs for states, and have no real impact on employment rates.

Still, Congress is considering this policy—not because it helps working families, but because it reduces federal Medicaid spending. The savings, in turn, are being used to help pay for tax cuts benefiting the wealthy and large corporations.

This is especially dangerous for people living with HIV. Medicaid is the single largest source of federal funding for HIV care, making it a lifeline—not just for health, but for survival. It ensures access to the medications that keep people with HIV healthy and virally suppressed, which also means they can’t transmit the virus to others. In this way, Medicaid is not just a health program—it’s a work support program. It helps people stay healthy enough to hold jobs and live independently.

In states without Medicaid expansion, most people with HIV who qualify do so only because they’ve already become disabled. Forcing people to go without treatment until they reach that point is not only cruel—it’s counterproductive and dangerous.

If these work requirements become law, the consequences will ripple through the entire HIV care system. Ryan White programs will face increased demand they can’t meet. Waitlists for life-saving medications like those offered through ADAP will grow. And fewer people will have access to HIV prevention tools like PrEP, leading to more new infections.

We cannot let this happen.

 

People with HIV and those who care about them need to take action now. Tell your Member of Congress and your Senators to oppose any proposals that would add a work requirement to Medicaid. You can call: 1-866-426-2631, use 5calls.org, or send emails with the AIDS United Action Alert at: https://aidsunited.org/action/policy-action-center/protect-medicaid/.

Click here to view our previous issue: Your Medicaid Benefits Are Under Attack! (4/29/2025)

This action alert was released May 9, 2025, by NMAC and The AIDS Institute. It is republished with permission.