Gerald Lee Joyce died from AIDS at age 43 on February 10, 2017. His sister recounted his final months on The AIDS Memorial, an Instagram account to remember those lost to this terrible disease that continues to take some 20,000 lives in the U.S. every year. Gerald had no health insurance and was undiagnosed for years. His condition was revealed only after his arrest for erratic driving, which ultimately lead to the discovery of lesions on Gerald’s brain. Three months later, he was dead.
Gerald’s and countless other lives could have been saved if his home state, Tennessee, expanded Medicaid. The Affordable Care Act (ACA) established a new Medicaid category for low income adults. However, ten states, including Tennessee, have, so far, refused to implement the expansion.
Medicaid expansion has been a game changer in the fight against AIDS. Before the ACA, most people with HIV did not qualify for Medicaid because they were not sick enough.
Medicaid expansion has been a game changer in the fight against AIDS. Before the ACA, most people with HIV did not qualify for Medicaid because they were not sick enough. Once their disease progressed to a full AIDS diagnosis, they could qualify for Medicaid on the basis of disability. The cruel irony is that medications and medical care that can keep people with HIV healthy remain out of reach for many until they get seriously ill.
Medicaid is the largest source of insurance coverage for people with HIV in the U.S., covering approximately 40% of adults living with HIV. With access to essential services like prescription drugs including anti-retrovirals, doctor’s visits, mental health and substance use disorder services, and more, people with HIV can live longer, healthier lives thanks to Medicaid. Medicaid also covers HIV testing and is a key provider of HIV prevention medications, PreExposureProphylaxis (PrEP).
However, these important gains in HIV care are under threat. The incoming administration and Congress are threatening to cut Medicaid funding by radically restricting how the program is financed. Proposals under discussion include turning Medicaid into a block grant, which limits the funding that goes to states, leading to cuts in services and eligibility. When Congress considered Medicaid block grants in 2016, analysts predicted up to 21 million people would lose coverage. People with HIV and AIDS who lose Medicaid have limited options for accessing treatment. For example, the AIDS Drug Assistance Program (ADAP), which is already operated as a block grant, has been marred by waiting lists that ended only after the ACA became law.
Other proposed Medicaid changes include reducing the amount of federal funding states receive for Medicaid expansion. Some states have “trigger” laws that automatically end Medicaid expansion for low income adults if federal funding goes down. Most states are experiencing budget crises and would be hard pressed to make up for the loss of federal funds.
Additional possible changes from the new Republican trifecta include mandatory work requirements for most Medicaid enrollees. When Arkansas imposed Medicaid work requirements several years ago, more than 18,000 people lost Medicaid coverage, mostly due to the red tape and bureaucratic reporting requirements, with many exempt persons falling through the cracks. Georgia’s imposition of work requirements has enrolled just 4,500 people, well short of the state’s projected 25,000 enrollment goal, and the 360,000 who could be eligible under Medicaid expansion.
On this World AIDS Day, December 1, 2024, we mourn our loved ones and the millions more who have died. Come January 2025, when the new administration and new Congress take office, the Medicaid program will be in their crosshairs. We better be ready to fight like hell for the living.
Fight AIDS! Protect Medicaid!
