The Medicaid program is a federal-state partnership that provides access to health care for nearly 70 million people in the United States, and is the largest source of health care coverage for people living with HIV. Medicaid plays a critical role in providing access to health care for people with low incomes, including helping to prevent and manage chronic conditions and to address health disparities seen across racial, ethnic, and socioeconomic divides.
Despite Medicaid’s critical importance, in 2025, Congress passed the largest cut to Medicaid in the program’s history. Many of these cuts will come in the form of new work requirements imposed on people who access Medicaid through the Affordable Care Act’s Medicaid expansion.
Our Approach
CHLPI is working with our partners to mitigate the impact of the 2025 cuts on people living with HIV and other chronic conditions. See, for example, the following resources:
- Massachusetts v. Oz, No. 26-12962 (D. Mass.), Plaintiff States’ Memorandum in Support of Their Motion for Partial Summary Judgment, Exhibit 54, Declaration of Elizabeth Kaplan (describing the impact of the 2026 Medicaid work requirements Interim Final Rule on people living with HIV) (2026)
- Health Care in Motion: New Medicaid Work Requirements Rule Threatens Access to Care for People with Chronic Conditions
- Letter to the Office of Management and Budget: Protect Access to Medicaid for People with HIV (2026)
- Elizabeth Kaplan and Carmel Shachar, Work Requirement Exemptions Based on Medical Frailty: We’d Better Get Them Right This Time, Health Affairs Forefront (Jan. 12, 2026)
- CHLPI survey of state policies on medical frailty and special medical needs in the Alternative Benefit Plan and Section 1115 waiver contexts (with highlights for HIV-specific policies)
- Letter to the Centers for Medicare and Medicaid Services: Medicaid Community Engagement Reporting Requirement (2025)
- The New Medicaid Community Engagement Requirement: What Public Health Officials and Providers Should Know
CHLPI also frequently submits comments on Medicaid Section 1115 waivers, which allow state Medicaid programs to design and test new approaches to administering the Medicaid program. Section 1115 waivers are opportunities for states to deviate from federal Medicaid law, although waivers must “promote the objectives of the Medicaid program”—to provide health care coverage for low-income individuals.
- Public Comment: CALAIM Renewal Demonstration (2026)
- Public Comment: MassHealth Amended 1115 Demonstration Request (2023)
- Public Comment: New York State Medicaid Section 1115 Proposed Waiver Amendment (2022)
Other Medicaid resources:
- HHCAWG Letter: Comments on Medicaid Work Requirements (2026)
- HHCAWG Letter: Protecting Medicaid from Cuts (2025)
- HHCAWG Letter: Protecting Medicaid from Cuts (2023)
- HHCAWG Letter: Recommendations for Future Guidance to State Medicaid Programs on HIV Prevention, Care, and Treatment Services (2022)
- Filling the Medicaid Coverage Gap: A Federal Policy Priority for People Living with HIV (2021)
- Letter: Closing the Medicaid Coverage Gap (2021)