Letter to Secretary Kennedy opposing changes to the PRWORA that limit testing, treatment, and prevention for communicable diseases
Secretary
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington DC 20201
Submitted electronically via the federal Regulations.gov portal (Docket AHRQ-2025-0002)
Dear Secretary Kennedy:
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.
Thank you for the opportunity to comment on new guidance the Department of Health and Human Services has issued on the interpretation of “federal public benefits” under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). We oppose any changes that limit access to testing, treatment, and prevention for communicable diseases, including HIV and hepatitis. New limits on access by “non-qualified” immigrants to healthcare for the testing, treatment, or prevention of communicable disease endanger not just those individuals, but by allowing communicable diseases to go undiagnosed, untreated, and unprevented, increase transmission, raise prevalence, and endanger the health of everyone in the United States.
Healthcare for Communicable Diseases Must Remain Accessible to All
To protect public health, Congress included a statutory exemption in PRWORA for healthcare related to communicable diseases, including HIV and hepatitis. HHS must continue to comply with the law and clarify that the prevention, testing, and treatment of communicable disease remain universally accessible—regardless of federal funding source—across all healthcare settings, including at federally qualified health centers (FQHCs) and Title X clinics.
HIV provides a clear example of why Congress saw fit to include communicable disease exception to federal public benefits inaccessible to “non-qualified” immigrants. Without access to treatment, HIV can be readily transmitted to others. For this reason, limiting access to HIV healthcare services (including testing, PrEP, and treatment) based on immigration status harms the entire community and endangers decades of progress towards ending HIV.
Viral hepatitis further underscores the critical importance of the communicable disease exemption. Hepatitis C, now curable with antiviral therapy, and hepatitis B, manageable with effective treatment, are leading causes of liver failure and liver cancer. Without access to testing and treatment, these infections can progress undetected for decades, eventually requiring costlier interventions like liver transplants and cancer care, burdening the health system far more than early diagnosis and treatment. Restricting access based on immigration status would allow ongoing transmission, increase future costs, and reverse progress towards the elimination of viral hepatitis. Ensuring universal access to hepatitis testing, prevention, and treatment is a cost-saving measure that protects the health of the entire community.
Another significant communicable disease that intersects with HIV is tuberculosis (TB), whose control has been a public health priority for over a century. Universal TB care must not be curtailed and is essential because drug-resistant strains—such as multi-drug resistant (MDR) and extensively drug-resistant (XDR) TB—can spark outbreaks that are exponentially harder and more expensive to contain, jeopardizing progress toward TB elimination.
Communicable diseases may also intersect in syndemics. For example, many people with HIV and hepatitis experience substance use or mental health conditions. Programs like those under SAMHSA include HIV and hepatitis components to address these overlapping challenges. For this reason, it is counterproductive to include services such as the Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG) within the scope of federal public benefits that are not accessible to “non-qualified” immigrants.
Community Health Centers Are Key to Provision of Healthcare for Communicable Disease and Are Required to Serve Everyone in Their Service Area or Population
Federally Qualified Health Centers (FQHCs) are required by statute to serve everyone in their service area or population. They also play a critical role in access to healthcare related to communicable diseases, such as HIV and hepatitis. FQHCs serve over 1 in 10 people nationwide but prescribe 1 in 4 prescriptions for HIV pre-exposure prophylaxis (PrEP) and provide care for 1 in 6 people living with HIV. The new HHS guidelines which list “Health Center Services” as a non-exempt Federal Public Benefit jeopardize this infrastructure, harming all Americans. We urge HHS to remove Health Center services from the list of Federal Public Benefits. At a minimum, HHS must provide clear implementation guidance for health centers that unambiguously exempts communicable disease care.
Non-Profits Must Not Be Compelled to Verify Immigration Status
Congress also recognized in the PRWORA statute that non-profit charitable organizations are not required to verify immigration eligibility for federal public benefits (8 USC 1642(d)). Most entities that provide HIV and hepatitis treatment and prevention services are non-profits. Immigration status determinations are legally complex and administratively burdensome, requiring extensive training and beyond the scope of healthcare providers’ expertise and capacity. We urge the administration to comply with the law and reaffirm clearly and unambiguously that non-profit organizations are exempt from verification requirements to avoid diverting resources from life-saving care.
If you have any questions, comments, or would like to discuss these issues further, please contact Carl Schmid, Executive Director, HIV+Hepatitis Policy Institute at cschmid@hivhep.org or (202) 462-3042; or Kevin Herwig, Health Policy Manager, HIV+Hepatitis Policy Institute at kherwig@hivhep.org or (617) 666-6634.
Sincerely,
Carl E. Schmid, II
Executive Director