Author: Sofia Dewey, an intern in AIDS Funding Collaborative
For over a decade The Act on inexpensive care (ACA) AND Medicaid expansion They served as necessary lines of life for necessary health care for low-income adults-especially people living with HIV/AIDS.
Forty percent of Americans living with HIV/AIDS are Medicaid.
However, the proposed labor requirements, restrictive federal policies and administrative burdens threaten the solution to these profits, and fresh changes in politics create a fragmentary and increasingly inaccessible healthcare system for people living from HIV.
Resources based on community are critical security networks-but they cannot replace wide Medicaid access. Emergency financial assistance, real public financing and directed assistance will be necessary to prevent people from falling through cracks.
These changes in politics do not affect the night, but preparation is necessary that people living with HIV remain associated with the care, treatment and support they need to live long and well.
Medicaid expansion in Ohio
Before 2010, Medicaid protection in Ohio was constrained.
This included children in families with income in the amount of or below 200 percent Federal poverty level (FPL) and parents aged or lower than than below, with several insurance options for adults aged 19–64 who did not have access to insurance sponsored by employers.
FPL is a federal income measure used to determine the eligibility for public programs; For one person in 2025, 100 percent of FPL is around USD 15,000 per year.
Aca has created Health insurance marketA centralized federal platform, in which people earning between 100-400 percent FPL can compare insurance plans and access tax breaks, opening fresh possibilities for people with HIV/AIDS to secure and maintain inexpensive healthcare.
Since the extension of Medicaid in Ohio in 2014, hundreds of thousands of inhabitants with low income have gained access to care. The expansion of Medicaid meant that adults under 65 years of age with income up to 138 percent FPL qualify for covering.
From May 2025, about 770,000 Ohioans have been enrolled in Medicaid. At Cleveland, about 45 percent of residents are based on Medicaid due to their healthcare needs.
Forty percent of Americans living with HIV/AIDS are Medicaid for comprehensive and inexpensive healthcare. Medicaid is the largest source of federal financing of healthcare related to HIV, including chronic conditions, mental health care and necessary treatment. Black residents – who represent 58 percent of Medicaid registration in Cleveland and 57 percent of HIV cases – especially benefits.
. 2025 Cleveland Health Survey There were no significant differences between Medicaid and private recipients in the field of routine access to care, mental health services or delaying care due to costs. This is a significant discovery, considering that Medicaid registrains often encounter greater social and financial uncertainty.
These profits are now threatened.
In the states that have expanded Medicaid, like Ohio, adults earning up to 138 percent FPL qualify for Medicaid.
On the other hand, countries that have not decided on expansion-states inconsistent with expansion-will make about 1.5 million adults in “luce insurance”, earning too little for subsidies (available only from 100% FPL, but not below), but too much for Medicaid.
Impact on the Ryan White Hiv/AIDS program
Named in honor of Ryan White, a teenager from Indiana, who stood in the face of discrimination and got up on HIV Stigma, RYan White Hiv/AIDS program Funds necessary medical care services and support for people with low HIV income.
As a “last resort payer”, Ryan White funds are used after all other insurance options are exhausted. Since the implementation of Aca Ryan White, he has expanded his support – offering not only treatment services, but also supporting or wrapped services that support people stay care.
- Part A Supports qualifying metropolitan areas with high HIV loads, financing both medical services and support. Planning councils based on community in these areas (such as the one in Cuyahoga and 5 surrounding poviats) ensure that the services reflect the needs of local populations, including people from HIV.
- Part b provides subsidies for states and territories, including financing AIDS Drug Assistance Program (adap)which provides drugs and includes insurance premiums and co -orients.
In Ohio, Adap (OHDAP) programFinaned mainly by Ryan White Part B, it includes residents earning up to 500% FPL. In 2023, 66 percent of adap customers earned on or below 200 percent of FPL, and 41 percent was or below 100 % FPL.
Adap will not be able to absorb all unsatisfied needs resulting from Medicaid losses and cannot look after the conditions outside HIV, leaving people without protecting the joint conditions.
Requirement
In addition, it complicates the landscape for ohioans living from HIV, Ohio Department of Medicaid (ZDZ) He submitted to the federal government a plan to implement work requirements for Medicaid registration in expansion.
A recent federal reconciliation or HR 1 includes Requirement In the case of all registration in Medicaid, and it is still unknown exactly how the impact of policy of state and federal work requirements will become.
The reported Ohio plan says that in order to remain qualified for expansion, you must have at least 55, employed, enrolled in educational programs or treatment or have a solemn medical or mental health.
“Employment” is widely defined as unpaid care, volunteering, internships, social service or unemployment.
In addition, the Act on reconciliation also places a federal ban on the enforcement of federal nursing staff in long -term care facilities that will affect the aging of people living from HIV.
If it is approved, these requirements will remain in force, unless you replace strict federal fines set for December 2026.
450,000 Ohioans of the endangered
While Ohio does not have a customary range in terms of range, as unproductive states do, this fresh policy is able to create it.
A fresh gap in the range for people earning between 0-100 percent of FPL will appear, because they will be qualified for Medicaid, but not saved, and do not qualify for subsidies, because subsidies do not start up to 100 percent FPL.
The refuse estimates that about 62,000 people will lose their rights, although this number does not include those who do not currently act. Including estimates state around 450,000 endangered.
In the case of people with HIV, these rules may delay the diagnosis, disturb care and threaten viral suppression-especially during the gaps in insurance verification during application and renewal (which will now require one month every six months).
This creates solemn barriers for newly diagnosed HIV and threatens to reduce access to care, quality and continuity of the care of Ohioans living from HIV.
Pigging registration, care continuity and quality standards, they threaten to reverse decades of profits in the results of supplementing health and HIV treatment results. Ding
Light
- To learn more about the cooperation of AIDS financing, Click here.
- Find a doctor who prescribes HIV preparation nearby, Click here.
- To find in your area a provider of medical medical program Ryan White Hiv/AIDS Click here.
- If you are a juvenile LGBTQ+ in crisis, please contact Trevor project: 866-4-U-TREVOR.
- If you are an adult transgender in need of immediate support, please contact National Trans Lifeline: 877-565-8860
