Proposed Changes to Medicaid will Harm People Living with HIV and Hepatitis


CONTACT: Kyle Taylor Director, Communications, NASTAD | 202-897-0029

Proposed Changes to Medicaid will Harm People Living with HIV and HepatitisShifting Medicaid to a block grant structure will limit access to coverage and hinder states’ ability to respond to public health emergencies

Washington, DC – The Centers for Medicare and Medicaid Services (CMS) released guidance today that would allow states to convert funding for some Medicaid recipients to block grants. The guidance encourages states to apply for Section 1115 waivers for Medicaid recipients enrolled under the Affordable Care Act’s Medicaid expansion (individuals with income up to 138% of the federal poverty level) – a change that would allow states to cap their spending on those patients, and in turn to reduce benefits to stay within the cap. This radical change to the structure of the Medicaid program will be devastating to people living with HIV and hepatitis and would curb or even reverse the progress and momentum behind plans to end the HIV and hepatitis epidemics.

“Medicaid is a critical source of coverage for people living with and at risk for HIV and hepatitis,” said Amy Killelea, Senior Director of Health Systems and Policy at NASTAD. “Block granting the program hinders our ability to end HIV and hepatitis by allowing states to slash benefits – including access to medications – to achieve cost savings. Adding limited protections for HIV medications does not save what is at heart a short-sighted and cruel policy decision designed to undercut the core purpose of the Medicaid program.”

Block granting Medicaid would also reduce states’ ability to respond to changing demographics and needs. Medicaid works because it is there when people need it. A block grant takes away an important safety net when people lose access to insurance (putting additional pressure on already strained public health and hospital systems) and hamstrings states’ ability to respond to emerging public health threats. Moreover, this policy decision is aimed squarely at undercutting the ACA’s Medicaid expansion, despite overwhelming evidence that the expansion has saved lives and improved health.

“Rolling back Medicaid access and weakening the ACA’s Medicaid expansion is at odds with the Administration’s bold initiative to End the HIV Epidemic,” continued Killelea. “To be successful, the initiative depends on state partnerships with Medicaid, with the recognition that we cannot end an epidemic with public health grant programs and resources alone. The guidance allows, but does not mandate, states to use this new flexibility. It will be up to state policymakers to choose to protect Medicaid and the populations the program serves.”



Founded in 1992, NASTAD is a leading non-partisan non-profit association that represents public health officials who administer HIV and hepatitis programs in the U.S. and around the world. Our singular mission is to end the intersecting epidemics of HIV, viral hepatitis, and related conditions. We do this work by strengthening domestic and global governmental public health through advocacy, capacity building, and social justice.