By Rachel Klein, deputy executive director, The AIDS Institute; and Joe Huang-Racalto, director of strategic partnerships and policy, NMAC

Right now, Congress is making decisions that could devastate health care for people living with HIV — and most Americans are unaware of the looming threat. NMAC and The AIDS Institute are raising the alarm about proposals that would drastically cut Medicaid funding and access, hidden behind terms like “block grants,” “per capita caps,” “work requirements,” and “waste, fraud, and abuse reforms.” The impact is clear: fewer people living with HIV will have access to the care they need to survive and thrive.

Medicaid is a lifeline for hundreds of thousands of people living with HIV. It provides essential services like medications, regular doctor visits, viral load monitoring, mental health support, and substance use treatment. Medicaid is the largest source of insurance coverage for people with HIV in the United States, covering an estimated 40% of the nonelderly adults with HIV, compared to just 15% of the nonelderly adult population overall (Source: KFF.org). Without Medicaid, the progress we’ve made in fighting the HIV epidemic would be reversed — and lives would be lost.

Two major threats are unfolding simultaneously:

  1. Block Grants and Per Capita Caps: These proposals would impose strict limits on Medicaid funding, regardless of need. In times of public health crises, economic downturns, or rising drug costs, states would face painful cuts to eligibility, benefits, and provider payments. We must demand protections that address the specific needs of people living with HIV, sexually transmitted infections (STIs) and viral hepatitis.

  2. Other Medicaid Cuts: Congress is also considering harsh work requirements, reduced federal support for Medicaid expansion, and limits on provider taxes that fund state Medicaid programs. These measures disproportionately harm Black, Latinx, LGBTQ, and low-income communities, many of whom rely on Medicaid for their health care.

Cuts are cuts — no matter how they are framed. Reducing federal Medicaid spending means fewer people getting coverage, less access to care, longer wait times, and worse health outcomes. Every dollar taken away from Medicaid is a dollar taken away from someone’s ability to live a healthy, full life.

People living with HIV have fought too hard to see their health care stripped away under misleading promises of “reform” or “efficiency.” We’ve seen this playbook before: politicians using complex language to disguise devastating cuts. We won’t be fooled, and we won’t stay silent.

Take Action Now: NMAC and The AIDS Institute urge everyone who cares about ending the HIV epidemic to speak out. Call, email, or visit your members of Congress and demand: No block grants. No cuts. No backdoor attacks on Medicaid. Check out this Action Alert from AIDS United to make your voice heard today.

This action alert was released April 29, 2025, by NMAC. It is republished with permission.