Objective:

To analyze the implications of the CMS interim final rule on Medicaid work requirements for individuals with HIV.

Approach:

• Regulatory Overview: The article discusses the CMS interim final rule issued on June 1, 2026, which mandates states to implement Medicaid work requirements, impacting eligibility for individuals with HIV.
• Legal Challenges: Twenty-six states and two governors have sued CMS, arguing that the requirement for a two-part test to qualify for medical frailty is contrary to the reconciliation law.
• Impact on HIV Population: The analysis highlights that Medicaid is the primary insurance for people with HIV, with nearly 46% covered by Medicaid in 2023, and the new requirements could significantly affect their access to care.

Key Findings:

• The new rule imposes a two-part test for medical frailty, making it harder for individuals with HIV to qualify for exclusions from work requirements.
• Access to antiretroviral medication is critical for managing HIV, and losing Medicaid could lead to more severe health conditions.
• People with HIV are more likely to have additional chronic conditions, substance use disorders, and mental health issues compared to those without HIV.

Interpretation:

The rule's definition of medical frailty may disproportionately affect individuals with HIV, potentially limiting their access to necessary healthcare services.

Limitations:

• The rule lacks guidance on how to assess whether a condition limits an individual's ability to meet community engagement requirements.
• States have discretion in creating lists of medically frail conditions, which may not comprehensively include all relevant diagnosis codes for HIV.

Conclusion:

The implementation of Medicaid work requirements poses significant challenges for people with HIV, particularly regarding access to care and management of their health conditions.