The Trump administration has taken steps to fundamentally re-shape the Medicaid program and undermine its core purpose. Since it was enacted in 1965, Medicaid has been a state-federal entitlement program that ensures health care coverage for those who are eligible – people with disabilities, children, and certain low-income adults. For every dollar the state spends on Medicaid, the federal government also pays into the program. This enables the states to be responsive to need: as health care costs rise or more people become eligible for Medicaid, the federal government chips in more to ease the burden on the states.  

On January 29, the administration issued guidance to give states the option of shifting their Medicaid funding to a block grant structure. Instead of an open-ended partnership, the state would receive a fixed sum each year. The block grant structure is not mandatory and would not impact all Medicaid beneficiaries. However, states that opt into block grants could cut health care benefits, raise co-pays, change eligibility, or cap enrollment for certain groups. They would also be subject to less federal oversight. Medicaid is the single largest source of health care coverage for people living with HIV, and millions could be impacted by the block grant guidance. PWN issued a statement condemning the Trump administration for this latest attack on health care and human rights.

Appeals court strikes down Arkansas Medicaid work requirements

This year on Valentine’s Day, a three-judge panel of the U.S. Court of Appeals in Washington D.C. showed some love for health care coverage. The panel unanimously ruled that Medicaid work requirements could not go into effect in Arkansas because the Trump Administration did not adequately consider the harm they would cause. Arkansas’s work requirements are a clear illustration of the devastating impact and injustice of work requirements. The requirements went into effect in June 2018 and were shut down in less than a year. During that time, more than 18,000 people were dropped from the state Medicaid program – and over 95% of the people who lost coverage were either working or should have been exempt from the requirement.

Latest funding opportunity for the Federal Ending the HIV Epidemic raises grave human rights concerns

The Centers for Disease Control and Prevention (CDC) released a “Notice of Funding Opportunity,” the latest step towards implementing the Trump Administration’s End the HIV Epidemic Plan (EtE plan). The funding opportunity invites health departments within EtE jurisdictions to apply for funds to develop and implement programs that meet EtE requirements and goals. Ending the domestic HIV epidemic is a laudable and achievable goal. However, advocates are concerned that the Trump administration’s approach is not only flawed, it is dangerous. PWN produced a factsheet last fall outlining our three primary concerns: the lack of meaningful community involvement, the lack of focus on structural barriers to prevention and care, and new surveillance and testing technologies which increase potential for human rights abuses that will affect people living with HIV. You can read more about each of these concerns here.

Sexual and Reproductive Health, Rights, and Justice

Trump Administration threatens to punish California for protecting access to abortion

California has long required insurers to cover basic health care services, and in 2014 the state clarified that reproductive health care — including abortion care — is basic health care. With exceptions for some religiously-affiliated insurance companies, private health plans in the state cannot treat abortion differently than any other pregnancy-related care. California’s policy helps ensure that insurance companies cover the full range of reproductive health services and do not interfere with the decision to have an abortion.

The Trump administration, however, is threatening to withhold federal health care funds unless the state drops the requirement. They claim that California’s policy violates the Weldon Amendment – a federal rule prohibiting local, state, and federal governments from requiring health care entities to cover, provide, or refer to abortion services. This issue has already been resolved. Four years ago the Department of Health and Human Services rejected a similar challenges to California’s policy. The administration is simply trying to punish California for protecting abortion access, threatening health care for millions in the process. Officials in the state have been clear that California will not be coerced into reversing its policy.

The Title X Domestic Gag Rule will stay in effect in most states in the U.S.

The nation’s only federally-funded family planning program – Title X – is in critical condition. Title X is critical pathway to basic reproductive health and preventive care for about four million people, primarily those who are poor or have low income. This month, the Ninth Circuit Court of Appeals upheld a policy that bans Title X funds from going to health care providers who perform or refer patients for abortion services. It is called the “domestic gag rule.” The rule “gags” health care providers by prohibiting them from telling patients about all of their pregnancy-related options and makes it impossible for health care facilities that provide abortion, like Planned Parenthood, from staying on the program.

The Ninth Circuit’s decision means that the domestic gag rule will continue to slash access to affordable sexual and reproductive health care services, especially for women of color and low-income women.

We know what to expect: the global equivalent of the “domestic gag rule” has forced clinic closures, caused increases in unintended pregnancies, and hampered HIV prevention efforts. Already, an estimated one-quarter of Title X sites left the program because of the domestic gag rule, and those sites provided care to nearly half of Title X patients served nationally. One state, Maryland, is safe from the domestic gag rule thanks to a court ruling blocking the rule from going into effect state-wide.

Economic Justice

Trump Administration’s racist and classist public charge rules go into effect

The Department of Homeland Security (DHS) public charge rule to took effect nationwide on February 24. It will stay in effect while the case proceeds through the courts. The public charge test impacts people applying for admission to the U.S. or for lawful permanent resident (LPR) status (otherwise known as a green card). It does not apply to humanitarian immigrants, such as refuges or survivors of domestic violence, or people who are already green card holders (unless they leave the U.S. for more than 6 months).

The DHS public charge rule adds new standards that make it more difficult for certain groups of people – such as people with low or moderate incomes or certain health conditions – to change their LPR status from within the U.S. There is a similar rule from the State Department that impacts admission or LPR status decisions made from outside the U.S. The regulations also expand the list of public assistance programs that might be considered for a public charge determination.

The public charge rules are complicated and do not apply to all immigrants. Most people can still use public programs like SNAP, Medicaid, and housing assistance without jeopardizing their immigration status. PWN and many other advocacy organizations have resolved to fight back against this racist policy and stand up for the rights, health, and safety of all immigrants.  

If you are unsure if the regulations apply to you, try to talk with an immigration attorney. Protect Immigrant Families also has an excellent Know Your Rights page that you can consult. If you want to help spread facts not fear, check out their  social media toolkit.  

Presidential Budget funds EtE efforts while decimating food, health care, and housing programs people living with HIV rely on

Trump released his Fiscal Year 2021 budget request. The proposed budget is unlikely to pass through both chambers of Congress. However, it provides good insight into presidential priorities. Trump’s priorities appear to be cutting social programs that help people meet their basic needs, increasing income inequality, and widening racial disparities.

The proposed budget would increase funding for the Federal End the HIV Epidemic (EtE) plan, yet it devastates programs upon which people living with HIV rely. It would cut $1 trillion from Medicaid and the Affordable Care Act over ten years and require all states to enact Medicaid work requirements. The proposed budget would cut essential food assistance by $182 billion over ten years; cut Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) for some people with disabilities; and drastically cut funding for housing benefits, including reducing the House Opportunities for Persons with AIDS (HOPWA) budget by $80 million.

HIV Epidemic Loan-Repayment Program (HELP) Act introduced in the U.S. House of Representatives

Representatives Barbara Lee (D-CA), Frederica Wilson (D-FL), and John Lewis (D-GA) introduced the HIV Epidemic Loan Prepayment Program (HELP) Act, H.R. 5806, on National Black HIV/AIDS Awareness Day. The Act would offer physicians, nurse practitioners, physician assistants, and dentists who provide HIV care in areas with health professional shortages or at Ryan White-funded clinics with up to $250,000 for loan repayment over five years. This would be a crucial step towards ensuring that health care professionals, including dentists, have the economic support they need to care for and support people living with HIV in underserved areas. You can ask your House Representative to co-sponsor the HELP Act here.

Other Updates!

---