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

Decision Ignores the Law & Requires People to be Impaired

Washington, D.C. — In response to the interim final rule released today by the Centers for Medicare and Medicaid Services (CMS) that provides guidance to states that have expanded Medicaid on how to implement the 80 hours per month community engagement provisions that begin on January 1, 2027, Carl Schmid, executive director of the HIV+Hepatitis Policy Institute, issued the following statement:

“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.”

The pressure will now turn to the states to implement these onerous requirements in just a few months by issuing rules, educating enrollees, and beginning the burdensome verification system. 

For the past several months, HIV+Hep has been urging the Trump administration to exempt people living with HIV and sent this letter to CMS Administrator Dr. Mehmet Oz, which was followed up with meetings at HHS, CMS, and OMB. Additionally, we sent this letter to all impacted state Medicaid Directors. Several states have responded positively that they would like to exempt people living with HIV pending the federal guidance. 

According to KFF, approximately forty percent of people living with HIV nationwide are enrolled in Medicaid and approximately 145,000 of them would be impacted by the new community engagement requirements. Any loss of Medicaid eligibility will put more financial pressure on other safety net programs, including the Ryan White HIV/AIDS Program and its already fiscally stretched AIDS Drugs Assistance Program (ADAP).

Comments on the interim final rule are due July 31, 2026.

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The HIV+Hepatitis Policy Institute is a national, non-profit organization whose mission is to promote quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.