National Institute of Allergy and Infectious Diseases

Without Medicaid, Deedee Burris, 53, of Chicago might not be here, or at least he'd likely be a lot less healthy.

Burris was diagnosed with HIV in 1995, and, for much of the past 15 years, he's been enrolled in Medicaid, a public insurance program that is jointly funded by the federal and state governments. It's provided Burris with affordable, consistent treatment that turned a fatal condition into a chronic illness.

"It plays a big role. You're able to get your medication, you're able to go to your doctor's visits, your ER [emergency room] visits," he said.

Medicaid covers 46% of people in the United States living with HIV, making it the largest source of insurance for Americans with this diagnosis. Eligibility is primarily determined by annual income—in most states the cutoff is $22,025 for a single adult. (Other factors include age and disability status.)

But starting January 1, 2027, Medicaid is changing in a big way, and the implications for people with HIV are severe.

We could certainly see increased HIV cases as a result.

A new rule, called the community engagement requirement, stipulates that adults must work, volunteer, or attend an educational or training program for at least 80 hours per month. Enrollees will have to verify that they meet this requirement twice a year or lose coverage.

It's expected that the additional administrative hurdles will be too onerous and complex for some people, including those with HIV. Burris predicts that some patients will lose access to treatment.

Advocates and policy experts who spoke to CIDRAP News for this story agree with Burris and warn that the loss of Medicaid coverage will not only harm individuals but public health as a whole.