Medicaid

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CMS fails to exempt people living with HIV from Medicaid work requirements

Jun 1, 2026

The law is very clear that people who have special medical needs, including those with a serious or complex medical condition, are statutorily exempt from the community engagement requirement. People living with HIV have a lifelong serious and complex medical condition and have special medical needs—they cannot stay healthy without continuous access to lifesaving HIV treatment. Any gap will put them at risk of serious health consequences. We are disappointed that the Trump administration ignored the law and, while they agree that HIV/AIDS and viral hepatitis are serious or complex medical conditions, they are proposing that states will have to determine for every individual if their health is impaired and that they can’t comply with the work requirement. This added requirement was not in the law and puts the health of people living with HIV and viral hepatitis at risk.

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Biden administration strengthens patient protections in accessing prescription drugs

Apr 26, 2024

“We applaud the Biden administration’s strengthening of the nondiscrimination regulation in order to ensure that patients, particularly those who rely on prescription drugs, are better protected against the discriminatory practices of some insurers and PBMs,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “Patients are being faced with high cost-sharing, excessive utilization management techniques, such as prior authorization, drug exclusions, and now even AI tools that decide what drugs they can receive. We can now be assured that, thanks to the ACA, they must be implemented in a nondiscriminatory manner.”

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Nation must do better in ensuring patients receive hepatitis C curative drugs

Jun 29, 2023

“This situation is completely unacceptable. We have a cure for a serious infectious disease, but people who have taken the time to get tested and know they have hepatitis C are not being cured,” commented Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The vast majority of these people have health coverage but payers such as private insurers, state Medicaid programs, and Medicare are erecting barriers to patient access by not covering medications or requiring cumbersome prior authorizations or imposing high patient cost-sharing. If the federal government is serious about ending hepatitis C, it needs to provide the leadership, particularly at CMS, and address these payer barriers.”

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Insurers warned that excessive utilization management of prescription drugs is potentially discriminatory

Jul 26, 2022

As part of the Biden administration’s proposed rule to implement the Affordable Care Act’s nondiscrimination provisions, excessive use of utilization management for prescription drugs, including prior authorization, step therapy, and durational or quantity limits could be deemed discriminatory. Additionally, the proposed rule adds back protections that prohibit insurers and other health programs from engaging in marketing practices and benefit design that discriminate on the basis of certain conditions, including disability. 

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