Arkansas Medicaid community engagement reporting requirement and people with HIV
Secretary and Medical Director
Arkansas Department of Human Services
112 West 8th Street
Little Rock AR 72201
Dear Secretary Mann:
The HIV+Hepatitis Policy Institute is a leading national HIV and hepatitis policy advocacy organization promoting quality and affordable healthcare for people living with or at risk of HIV, hepatitis, and other serious and chronic health conditions.
Thank you for offering the opportunity for public comment on a Section 1115 Demonstration Project Application to implement the new requirements on January 1, 2027.[1]
We write to urge the Arkansas Medicaid program to include an explicit exemption for all people living with HIV from the community engagement reporting required under 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.
People with serious and complex medical conditions and special medical needs are statutorily exempt from the community engagement requirement; however, absent federal guidance, states can define which populations qualify.
Arkansas Medicaid has previously stated that people receiving treatment for HIV will be considered to be in compliance with community engagement requirements (“on track”) in responses to public comment on a previously submitted 1115 waiver published in July 2025.[2] We urge Arkansas to reaffirm explicitly in the finalized current 1115 amendment that people with HIV–whether symptomatic or asymptomatic, or whether or not they currently receive or have ever received HIV treatment–have special medical needs and are exempted from falling under the new community engagement program.
This interpretation is consistent with long-standing federal precedents. For decades, Congress and Unites States DHHS have considered HIV (both symptomatic and asymptomatic) as a serious, life-threatening, and potentially disabling condition.[3]
All people with HIV should be exempted from the community engagement automatically, without having to navigate cumbersome new bureaucratic procedures to document their status with each Medicaid recertification.
Under statute, states are directed to maximize ex parte verification of eligibility in relation to the community engagement requirements. Automatic exemption through use of data already available to the Medicaid program (such as diagnostic codes and claims data) minimizes the burden on the enrollee. It also reduces the administrative burden on the state and on the health-care workforce providing care to people with HIV.
Arkansas asserts in its amendment that “DHS must review and verify all necessary information to determine compliance/exemption at the time of application and at redetermination as a condition of eligibility.”[4] Since HIV is a lifetime condition that will not change over time, any assessment should only be carried out once.
To put the onus on individuals living with HIV to navigate administratively cumbersome forms of verification of HIV status is unnecessary and puts their health at risk. In addition, since people with HIV face continuing stigma and discrimination, many are reluctant to disclose their HIV status in Medicaid enrollment and recertification paperwork, further amplifying the importance of using ex parte verification of HIV status.
Approximately forty percent of people living with HIV nationwide are enrolled in Medicaid, making Arkansas’s implementation of the new community engagement requirements of the highest importance to people living with HIV, their care teams, and communities. As the first state in the nation to implement work requirements in Medicaid in 2018, Arkansas has an opportunity to use this experience to put in place humane and clinically sound practice in compliance with HR1.
We encourage Arkansas DHS to engage people living with HIV and their clinicians to better understand the impact of these policies. We are ready to assist in any way. Should you have questions or comments, please feel free to contact me at cschmid@hivhep.org or Kevin Herwig at kherwig@hivhep.org. Thank you very much.
Sincerely,
Carl E. Schmid II
Executive Director
[1] https://humanservices.arkansas.gov/wp-content/uploads/ARHOME-Waiver-Long-Notice-12.12.25.pdf
[2] https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ar-arhome-ltr-frm-state-07082025.pdf (page 5)
[3] For example, 28 CFR 35.108(b)(2) or 78 FR 42233
[4] https://humanservices.arkansas.gov/wp-content/uploads/ARHOME-Waiver-Long-Notice-12.12.25.pdf (page 12)