Medicaid

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Letter to all Medicaid expansion states requesting HIV exemption from community engagement requirements

May 7, 2026

People with serious and complex medical conditions or special medical needs are statutorily exempt from the community engagement requirement. Federal implementation guidance due by June is expected to provide further detail on how states may implement this exemption.  While we are seeking a federal exemption, under the law, states are allowed to define which populations qualify for the exemption.  We urge Alaska Medicaid to explicitly state that HIV is a serious and complex medical condition and that all people living with HIV (both symptomatic and asymptomatic) have special medical needs and fall under this exemption. 

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Letter to Connecticut Legislature expressing concerns with the Joint Favorable Substitute of HB 5040 and impact on HIV medications

Apr 9, 2026

We would like to express our opposition to Section 2 and concerns with Section 3 of the Joint Favorable Substitute of HB 5040. Section 2 would remove protections for antiretroviral (ARV) medications for the treatment and prevention of HIV from the imposition of prior authorization or step therapy by allowing them to be given “non-preferred” status on Connecticut’s Medicaid Preferred Drug List (PDL). These protections have been in place for over two decades. Section 3 would allow Connecticut to conduct cost-effectiveness reviews of outpatient drugs in Medicaid that could rely on discriminatory measures that devalue patients and require comparisons between U.S. drug prices and those in foreign countries.

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Comments to Colorado Dept of Health Care Policy & Financing supporting the prohibition of prior authorization for HIV treatment and prevention in Medicaid

Feb 6, 2026

We urge Colorado to maintain the prohibition of prior authorization for HIV treatment and prevention in Medicaid. Timely access to guideline-recommended HIV treatment and prevention is critical for both individual and public health. These policies align with rapid scientific advancement. Reinstating prior authorization would disproportionately harm the most vulnerable. 

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Comments to MACPAC urging an exemption for people with HIV to the Medicaid community engagement requirement

Jan 26, 2026

As you develop your principles and policy options we urge MACPAC to recommend an explicit exemption for all people living with HIV from the community engagement requirement mandated by Public Law 119-21, also known as the One Big Beautiful Bill Act. People with HIV are living with a lifelong serious and complex medical condition and have special medical needs: they cannot stay healthy without continuous access to their lifesaving HIV treatment. Any gap in treatment risks serious health consequences, including failure of viral suppression and the risk of onward transmission. Longer treatment gaps are potentially disabling, allowing progression to AIDS, after which life expectancy is limited.

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Letter to CMS administrator requesting explicit exemption for all people living with HIV in the new Medicaid community engagement requirement

Jan 22, 2026

We write to urge you to include an explicit exemption for all people living with HIV in upcoming federal guidance relating to the new Medicaid community engagement requirement mandated by HR 1.

People with HIV are living with a lifelong serious and complex medical condition and have special medical needs: they cannot stay healthy without continuous access to their lifesaving HIV treatment. Any gap in treatment risks serious health consequences, including failure of viral suppression and the risk of onward transmission. Longer treatment gaps are potentially disabling, allowing progression to AIDS, after which life expectancy is limited.

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