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

Public Statement for the Record
Medicaid and CHIP Payment Access Commission (MACPAC)
January 2026 Public Meeting

Submitted by:
Carl Schmid
Executive Director
HIV+Hepatitis Policy Institute

Thank you for the opportunity to submit these public comments as MACPAC addresses the topic “Considerations for Implementing Community Engagement Requirements: Principles and Policy Option” at its January 2026 Public Meeting. 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.

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.

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.

This interpretation is consistent with long-standing federal precedents. For decades, Congress and the United States Department of Health and Human Services have considered HIV (both symptomatic and asymptomatic) as a serious, life-threatening, and potentially disabling condition.¹

We believe that all people living with HIV should be exempt from the community engagement provision automatically and should not have to navigate cumbersome new procedures to document their status with each Medicaid recertification. Since HIV is a lifetime condition that will not change over time, this assessment should only be carried out once.

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 states and on the health-care workforce providing care to people with HIV.

The onus to navigate administratively cumbersome forms of verification of HIV status should not be placed on individuals. Since people living with HIV face continuing stigma and discrimination, many are reluctant to discuss their HIV status in Medicaid enrollment and recertification processes, 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 humane and clinically sound implementation of the new community engagement requirements of the highest importance to them, their clinical care teams, and communities.

Continuous access to Medicaid for people living with HIV is critical to sustaining our national progress towards ending the HIV epidemic and will directly support the goals of the Ending the HIV Epidemic initiative launched by President Trump in his first administration.

We appreciate the opportunity to submit these comments and are ready to assist you in any way. Should you have questions or comments, please feel free to contact me at cschmid@hivhep.org. Thank you very much.