Administration Policy on Medicaid Work Requirements Harmful to People with HIV Statement of HIVMA Chair Melanie Thompson, MD

The administration’s new guidance on Medicaid work requirements opens the door for states to impose employment as a condition of Medicaid eligibility and runs counter to the Medicaid program’s objectives of providing a reliable and comprehensive source of healthcare coverage to individuals and families whose income, and/or disabilities put that coverage otherwise out of their reach. The members of the HIV Medicine Association are deeply concerned that imposition of work requirements threatens the health of millions of Americans who count on the program, including more than 40 percent of patients with HIV.

 Nearly 60 percent of Medicaid enrollees work, and nearly 80 percent are part of working families. Of those enrollees who are not working, 97 percent are either ill or disabled, providing care for family members, attending school, retired, or actively looking for work. These data reflect our experience, as HIV medical providers. Taking away Medicaid from people with HIV who are ill and not working robs them of the ability to get well and return to productive employment. The ability to work for many of our patients depends on maintaining access to the affordable and comprehensive medical care and treatment supported by the Medicaid Program. 

With care and treatment, individuals with HIV can achieve control of the virus allowing them to stay healthy with near normal life expectancies, while reducing their risk of transmitting HIV to virtually zero. Control of the virus, however, requires uninterrupted access to HIV medications and continuous access to primary care and preventive health services. Gaps in HIV treatment of even days to weeks increases the risk of transmission to others, and can lead to serious complications, including development of a virus that is drug resistant, and more difficult and costly to treat. Research has proven that interruption of HIV treatment results in disease progression and death. One of the best public health interventions we could implement toward eliminating the HIV epidemic would be to ensure that more, not fewer, persons with HIV receive appropriate medical care. Taking Medicaid away from people with HIV will inflame the epidemic, worsen health outcomes, fuel new infections, and cost more money - exactly the opposite of what federal health programs should be doing.

Should these waivers advance, we strongly urge very limited approval until a robust independent evaluation that monitors health outcomes, administrative burden and health system costs is conducted. It does not take a study to know that withdrawing Medicaid from low income and medically disabled people with HIV will end badly. In fact, that study has been done. These actions will cost lives, increase illness and hospitalizations, and result in new infections. There is no excuse for ignoring science and withholding lifesaving care from our fellow citizens with HIV. It is wrong for public health and for the public’s purse, and we simply cannot allow it to happen.