HIV and Medicaid Expansion: Failure of Southern States to Expand Medicaid Makes Elimination of HIV Infection in the United States Much Harder to Achieve

Advances in public health programs and medical treatment mean HIV can be treated successfully in the long term, improving the health of individuals and reducing the spread of the virus. While the federal government has multiple initiatives aimed at addressing and eventually eliminating HIV, a fundamental base to ensure successful health outcomes for people with HIV and their families is access to comprehensive, affordable health care coverage. A proven way to increase levels of coverage is for states to expand Medicaid under the federal Affordable Care Act (ACA).

Unfortunately, the 12 states—largely in the South—still refusing the federal funding for Medicaid expansion leave many people and families who could benefit from HIV interventions still lacking access to comprehensive health coverage. Expanding Medicaid would significantly improve health care and coverage for people with HIV and their families. Medicaid is the key building block to ending the epidemic. States that have not expanded medicaid coverage experience more

HIV infections and higher mortality rates from the condition. Failure to prioritize Medicaid expansion in dealing with HIV ignores extensive research and the fact that the center of the epidemic in the United States—the South—is also the center of resistance among states to expanding Medicaid. Federal and state plans to reduce and eliminate HIV infection must acknowledge the important role of Medicaid expansion.

Layered on top of the HIV epidemic is the current COVID-19 pandemic. Striking parallels between the response to HIV and COVID-19 were pointed out earlier this year in the course of the pandemic. The urgency of dealing with COVID-19 severely complicates the ongoing response to the HIV epidemic, making response to HIV and multiple other public health challenges more difficult. However, the basic fact remains that successful response to the HIV epidemic requires more health coverage through Medicaid expansion.