Our Interconnected HIV Care Financing System is Under Threat

Improving the health of people with HIV and reducing new cases requires maintaining and strengthening our nation’s complex and interwoven system of financing and delivering HIV prevention and care. Over time, the U.S. has expanded access to insurance coverage while retaining funding for the Ryan White HIV/AIDS Program (RWHAP) that helps people to navigate and access the insurance system, provides cost-sharing assistance so that low-income individuals can access insurance benefits and covers services when insurance coverage does not. It also provides HIV treatment and other services for people with HIV who are uninsured. Beginning in 2019 when President Trump launched the Ending the HIV Epidemic (EHE) Initiative, Congress has appropriated additional resources for both HIV prevention and care, including additional funding for the RWHAP. These policies and financial investments are driving progress, reducing the numbers of new HIV cases and increasing HIV viral suppression. All of these elements of the U.S. HIV care system, however, are under threat due to the reorganization and elimination of key functions at agencies of the Department of Health and Human Services (HHS) and through potential reductions in support for both discretionary HIV programs and our major national insurance programs.

Over time, our nation has built an increasingly effective and robust system of financing and delivering HIV primary and specialty care for people with and at risk for HIV in the U.S. Potential changes to Medicaid and private insurance, combined with reduced support for HIV programs, would lead the nation backward.

Learn More

Throughout this brief are hyperlinks to resources that can be found here:

1.KFF, Status of Medicaid Expansion Decisions, https://www.kff.org/status-of-state-medicaid-expansion-decisions/

2. KFF, 5 Key Facts About Medicaid Coverage for People with HIV, https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-coverage-for-people-with-hiv/

3. KFF, Insurance Coverage and Viral Suppression of People with HIV, 2018, https://www.kff.org/hivaids/issue=brief/insurance-coverage-and-viral-suppression-among-people-with-hiv-2018/

4. KFF, The Ryan White HIV/AIDS Program: The Basics, https://www.kff.org/hivaids/fact-sheet/the-ryan-white-hivaids-program-the-basics/

5. CHIDP, Quick Take: The Ryan White HIV/AIDS Program: The Program’s Parts Work Together to Make It Effective, https://oneill.law.georgetown.edu/publications/the-ryan-white-hiv-aids-program-the-programs-parts-work-together-to-make-it-effective/

6. KFF, Putting $880 Billion in Potential Federal Medicaid Cuts In Context of State Budgets and Coverage, https://www.kff.org/medicaid/issue-brief/putting-880-billion-in-potential-federal-medicaid-cuts-in-context-of-state-budgets-and-coverage/

7. KFF, Medicaid Work Requirements and People with HIV, https://www.kff.org/hivaids/issue-brief/medicaid-work-requirements-and-people-with-hiv/#:~:text=Overall%252C%2520we%2520found%2520that%252044,working%2520full%2520or%2520part%252Dtime.&text=Most%2520state%2520waivers%2520require%2520individuals,to%2520satisfy%2520the%2520work%2520requirement.

8. KFF, Eliminating the Medicaid Expansion Federal Match Rate: State-by-State Estimates, https://www.kff.org/medicaid/issue-brief/eliminating-the-medicaid-expansion-federal-match-rate-state-by-state-estimates/

9. KFF, Eliminating the Medicaid Expansion Federal Match Rate: State-by-State Estimates, https://www.kff.org/medicaid/issue-brief/eliminating-the-medicaid-expansion-federal-match-rate-state-by-state-estimates/

10. AIDSVu, AIDSVu Release New PrEP Data and Launches PrEPVu.org, a New PrEP Equity Platform, https://aidsvu.org/news-updates/aidsvu-releases-new-prep-data-and-launches-prepvu-org-a-new-prep-equity-platform/#:~:text=PrEP%2520Use%2520and%2520Medicaid%2520Expansion,that%2520had%2520not%2520expand%2520Medicaid.

11. Congressional Budget Office, Letter to Chairman Arrington and Chairman Smith, Re: The Effects of Permanently Extending the Expansion of the Premium Tax Credit and the Costs of that Credit for Deferred Action for Childhood Arrivals Recipients, https://www.cbo.gov/system/files/2024-06/60437-Arrington-Smith-Letter.pdf

12. KFF, How Much More Would People Pay in Premiums if the ACA’s Enhanced Subsidies Expired?, https://www.kff.org/interactive/how-much-more-would-people-pay-in-premiums-if-the-acas-enhanced-subsidies-expired/

13. KFF, https://www.kff.org