Quick Take: Medicaid Work Requirement Rule Will Push People with HIV Out of Care

Over the past ten plus years, major progress has been made at preventing and treating HIV.  Legislation signed into law last year as part of the One Big Beautiful Bill Act (OBBBA), however, will likely set back much of this progress. It established work requirements that require that adults covered by Medicaid expansion and some waiver programs complete 80 hours of work or community service activities per month or meet exclusion criteria to maintain coverage. The law contains an exclusion from the requirement for people who are “medically frail,” including people who have a “serious or complex medical condition.” States believed that this had given them a way to exclude people with serious health challenges like HIV.  In June 2026, however, the Centers for Medicare and Medicaid Services (CMS) issued an interim final rule (IFR) that prohibits states from categorically excluding people from work requirements based on their health status. While the rule lists HIV as a condition that could meet the medical frailty exclusion, it also cites it as an example of a condition that would not qualify if the acuity of the condition is not severe.

This Quick Take provides potential actions for HIV stakeholders to minimize the hard of this rule and the interim final rule.

Read the Quick Take