How Changes Coming to Medicaid Will Affect New Yorkers With HIV

**Brian Lehrer** (0:10)
Brian Lehrer on WNYC. In 2019, Donald Trump, during his first term, stood before Congress and made this pledge.

**Donald Trump** (0:19)
My budget will ask Democrats and Republicans to make the needed commitment to eliminate the HIV epidemic in the United States within 10 years. We have made incredible strides, incredible.

**Brian Lehrer** (0:39)
A pledge to end the HIV epidemic by 2030 Well, here we are seven years later, and it looks like the Trump administration has done something very different. Since returning to the White House, Trump has cut HIV prevention grants, shut down advisory committees working on policy initiatives, and allowed World AIDS Day, December 1st every year, to pass without a word from the White House. That's all been widely reported. Now comes another blow. This one's related to a new federal rule on its way in about Medicaid. The rule requires certain Medicaid recipients to work, volunteer, or attend school for at least 80 hours a month, or lose their coverage. That would start January 1st next year. It includes a, quote, medically frail exemption.
But advocates say that that exemption is written so narrowly, it could leave many thousands of people with HIV in a vulnerable position. In New York State, nearly half of all people living with HIV, which is an estimated 55,000 or so people, depend on Medicaid for their health care. Nationwide, Medicaid covers 40 percent of people with HIV at any given time. In addition to covering treatment and keeping people with HIV alive, Medicaid also funds things intended to prevent transmission. So we'll talk now about what these imminent Medicaid work requirements might mean for the New Yorkers and others who rely on Medicaid for HIV care. Our guest is Ginny Shubert, co-founder and senior advisor of Housing Works.
As many of you know, one of New York's leading organizations, serving people living with HIV and AIDS. Ginny, thanks for coming on for this. Welcome back to WNYC.

**Ginny Shubert** (2:25)
Thank you for having me.

**Brian Lehrer** (2:27)
And listeners, are you a New Yorker living with HIV or AIDS or who depends on Medicaid or both or do you work in HIV care or services? You're invited. What does Medicaid mean for your care or your community and what are you most worried about with these new work requirements?
Your calls can be about the work requirements, whether or not they pertain to HIV with you. So we can open it up that broadly. But 212-433-WNYC, 433-9692 caller text. Ginny, remind our listeners about the people Housing Works serves. Who are we actually talking about when we talk about New Yorkers on HIV with Medicaid?

**Ginny Shubert** (3:11)
Well, most people think of Housing Works as our thrift shops. But actually, the thrift shops are just the way that we fund our life-saving services and advocacy. So we operate six community health centers in underserved New York communities, where we provide primary care, substance use treatment, mental health care for over 10,000 New Yorkers a year. Among the people that we serve, about 16 percent are uninsured and 66 percent rely on Medicaid. Eighty-two percent of our patients rely on some form of public health coverage that's likely to be cut by HR1.
So, the people that we serve and have since the beginning are those that are most marginalized in the community, people living with HIV, but also with experiences of homelessness. About 41 percent of our patients are homeless at any one time. People who have had experiences of incarceration, mental health issues, substance use disorder.

**Brian Lehrer** (4:26)
People in New York City may have seen public service announcements that say the words, undetectable equals untransmittable. Undetectable equals untransmittable. That means that someone on effective treatment, even if they're HIV positive, cannot pass the virus on. What does Medicaid have to do with transmission? What do you anticipate happens to that public health equation if people lose coverage?

**Ginny Shubert** (4:53)
Well, HR. 1 work requirements, and let's just say this is the first time in the history of the program that work requirements have been imposed, is harmful enough and the Congressional Budget Office predicts it'll toss at least six million people nationwide off of coverage. But the new interim final rule that was published last week undermines a protection that Congress put into law to prevent interruptions of coverage for people who are medically frail and require ongoing continuous medical care to manage their condition, like people with HIV, people with cancer, and other serious and complex medical conditions. Now, this is going to accelerate the harmful effect.
Well, I'm sorry, what the interim and final rule does is impose a new requirement that is not in the law, that not only does a person have to have one of these conditions be medically frail, but they have to prove that their medical frailty prevents them from substantially complying or substantially impairs their ability to comply with the work requirements.