Late-breaking policy brief: Addressing the end of the COVID-19 public health emergency and Medicaid coverage cliff

The AIDSWatch planning partners — AIDS United, the US People Living with HIV Caucus and the Treatment Access Expansion Project/Center for Health Law and Policy Innovation — determine policy priorities for an AIDSWatch brief from recent legislative analysis, AIDSWatch community input and guidance from networks of people living with HIV. AIDSWatch 2022 advocates are undertaking an ambitious and responsive policy agenda, covering quality of life, aging, the meaningful involvement of people living with HIV in federal policy, civil rights, appropriations and several other issues. 

However, the policy process sometimes moves fast. While the planning partners drafted the AIDSWatch policy brief in recent weeks, there have been some key developments we want to make sure AIDSWatch advocates are aware of. We’re in a crucial moment for advocacy; some of our communities’ top priorities — closing the Medicaid gap, promoting racial equity, expanding access to PrEP and others — have a chance to be addressed by the 117th Congress. But we, as AIDSWatch advocates, have to ensure our Congress members know that we are watching.

Addressing the end of the COVID-19 public health emergency and Medicaid coverage cliff

The federal government declared a public health emergency in response to the COVID-19 pandemic. This set the stage for funding and policy changes that address the needs created by the COVID-19 crisis. Additionally, Congress passed a series of laws that significantly increased federal funding and flexibility for key health and social programs during the emergency.

The public health emergency declaration is likely to expire in the late spring or early summer. The end of the emergency means that much of the increased federal funding and flexibility will end too. This includes enhanced federal funding that requires state Medicaid programs to provide continuous coverage to all enrollees and the flexibility to increase support through food security programs like the Supplemental Nutrition Assistance Program and SNAP for Women, Infants, and Children. These investments have been a lifeline for many people living with and vulnerable to HIV, and the upcoming drop in funding will be catastrophic for the more than 16 million people who are expected to lose health coverage if Congress does not act. 

Congress must act now and enact a bill through a legislative process called reconciliation to help ease the impact of the end of the public health emergency and to address many of the underlying issues that have plagued our country for years.  

1. A reconciliation bill could stop a catastrophic loss of health care coverage.

The Build Back Better reconciliation bill that Congress debated last fall, but failed to pass, provided important opportunities to extend enhanced federal funding for Medicaid programs and private health insurance plans available on health insurance marketplaces. If Congress passes this legislation, an estimated 16 million people likely to lose access to Medicaid when the public health emergency ends could maintain or obtain access to lifesaving health care coverage.

2. A reconciliation bill could close the Medicaid coverage gap.

Twelve states, primarily in the United States South, have not expanded Medicaid eligibility.  A reconciliation bill could help close this Medicaid coverage gap and provide low-income individuals and families with a means of accessing necessary health care coverage.  

3. A reconciliation bill could address persistent health disparities.

A reconciliation bill could address disparities in access to care and health outcomes experienced by Black, Indigenous and other people of color by investing in key initiatives, including comprehensive maternal health programs, bias training for health care professionals and funding to address growing environmental hazards. Other reconciliation measures, such as enhanced food assistance for low-income school-aged children during the summer, would serve as a critical safety net and help address food insecurity exacerbated by the pandemic.

We must encourage all members of Congress to enact a reconciliation bill that will protect ongoing access to care, treatment and essential services for people living with HIV after the public health emergency ends.