Healthcare and politics are deeply intertwined. Government decisions directly determine who gets care, what treatments are available, and how easily patients can access care.
January 2025 marked the start of President Trump’s second term in office, and with it, deep federal funding cuts.
Our January post, published a few days before Trump’s inauguration, explored the impact of federal funding on HIV and AIDS at home and abroad. At the time, we were hopeful that the new administration would help to close the gap to eradicating pediatric HIV and AIDS—especially after his first-term promise to reduce HIV infections by 90% by 2030 through the Ending the HIV Epidemic (EHE) program.
But the reality has been stark. The administration had eliminated the international AMFAR/USAID HIV programs and failed to increase funding for the Ryan White Program, which bridges financial gaps in coverage for domestic HIV patients Now, nearly eight months into his presidency, the so-called “One Big Beautiful Bill” (signed July 4, 2025) has slashed a staggering $1 trillion from Medicaid over the next decade (2025–2034). This is catastrophic: Medicaid is the largest funder of HIV prevention in the country (1, 5).
The implications of this bill are far-reaching, but one thing is clear: Medicaid cuts threaten to reverse progress toward ending HIV—and children will pay the price.
We Were Close to Ending the HIV Epidemic
For years, Medicaid has been a beacon of hope in the fight against HIV. As the largest insurer for people with HIV, Medicaid covers 40% of non-elderly adults with HIV and 15% of non-elderly adults overall (1). Add in KIDS! The program has historically funded screenings, PrEP (pre-exposure prophylaxis), and treatment for HIV essential tools to control the epidemic (5). With the passage of the Affordable Care Act, Medicaid expansion programs bolstered HIV services and were required to cover preventative services like HIV screening and PrEP without cost-sharing, reducing barriers to access and increasing prevention (1).
That foundation allowed targeted federal initiatives like EHE to build momentum. In 2024, nearly $2.6 billion was dedicated to HIV care through Medicaid and related programs, including $165 million specifically for EHE (8). Launched during Trump’s first term, EHE aimed to reduce new HIV infections by 90% within a decade with the Ryan White Program becoming central to this mission, providing the “care pillar” to complement Medicaid’s prevention efforts (8).
These systems were working not just for adults, but for children. Expanding access to maternal screening, antiretroviral therapy during pregnancy, and postnatal prophylaxis made perinatal HIV transmission increasingly rare in the U.S. (7). We were finally within reach of a generation born free of HIV.
Medicaid Cuts Threaten to Reverse This Progress
Now, the OBBB’s Medicaid cuts put that progress in jeopardy. Reducing federal funding forces states to either raise taxes or cut services (2, 5). Medicaid spending on HIV is already rising—due to growing enrollment and the high cost of antiretrovirals (1).
At the same time, the Trump administration has:
- Proposed eliminating EHE funding (8)
- Proposed cutting Ryan White’s Part F (8)
Moreover, new work requirements could strip coverage from people with HIV—especially low-income parents and caregivers leaving them reliant on an already underfunded Ryan White system (2). With EHE and Ryan White’s future uncertain, the very safety net that has prevented pediatric infections is starting to unravel.
The Human Consequences: More HIV, Worse Outcomes
Without Medicaid, the fallout will be serious. Research shows losing coverage leads to higher rates of AIDS, more new infections, overwhelmed Ryan White clinics, and treatment interruptions that worsen health and increase transmission (2, 5). Even small barriers—like extra paperwork or fees—can delay care for low-income patients, increasing long-term health costs (6).
Children are especially vulnerable. When parents lose coverage, their children often do too—even if the kids remain eligible (4).
We’ve already seen this happen: During the post-COVID Medicaid unwinding, administrative errors in several states caused thousands of eligible children to lose Medicaid coverage (4).
Unfortunately, these one-time mistakes are now becoming part of ongoing policy decisions, increasing the risk that children who rely on Medicaid for HIV-related care will fall through the cracks.
Children Will Fall Through the Cracks
Optional Medicaid coverage groups—like children in families earning above 138% of the poverty line or those with disabilities not on SSI—are especially at risk (4).
Today, half of all U.S. children rely on Medicaid or CHIP (4). If families lose eligibility or face new administrative burdens, critical pediatric HIV services could disappear or become inaccessible, including:
- Postnatal HIV prophylaxis for exposed infants (7)
- Early HIV detection during pregnancy (7)
- Ongoing testing and treatment for at-risk children (7)
Even with exemptions for pregnant women, stricter income limits may push them out of eligibility (9). That means missed screenings, missed doses, and entirely preventable infant infections.
In states with weaker Medicaid systems, perinatal HIV transmission rates are already 5 to 6 times higher than the national average (Placeholder F). Slashing care now will only make that gap wider.
A Future Shaped by Policy—Not Medicine
Pediatric HIV is preventable. We know how to test, treat, and protect pregnant women and their children. But when access to care depends on unstable insurance coverage, even short gaps can have lifelong consequences.
Policy-driven funding cuts threaten to reverse decades of progress—leaving families without care, fueling preventable infections, and creating a new generation of children born with HIV. By the time the consequences of further Medicaid cuts to an already fragmented federal HIV funding system are visible in infection rates and infant mortality, it will be far too late to act.
Call to Action
If you want to help, start here: join our organization and donate or step in where government support has been pulled back. Share this post with your community, ask questions, and be a proud advocate.
The Junior Council is mobilizing everyday people to protect access to HIV prevention and care. Because no child should be born with HIV when we have the tools to prevent it.
Disclaimer: The Junior Council is not affiliated with any political group.
Citations
- https://www.kff.org/hivaids/issue-brief/medicaid-and-people-with-hiv/
- https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-coverage-for-people-with-hiv/
- https://www.americanprogress.org/article/the-truth-about-the-one-big-beautiful-bill-acts-cuts-to-medicaid-and-medicare/
- https://www.commonwealthfund.org/blog/2025/deep-medicaid-spending-cuts-put-health-care-coverage-risk-one-five-enrolled-children#:~:text=With%20everything%20on%20the%20table,and%20services%20must%20be%20covered.
- https://www.theaidsinstitute.org/RRA/fact-sheet-cutting-medicaid-threatens-plans-to-end-the-hiv-epidemic
- https://www.idsociety.org/news–publications-new/articles/2025/house-moves-to-strip-health-coverage-from–millions-of-americans-including-many-people-with-hiv/
- https://publications.aap.org/pediatrics/article-abstract/156/1/e2025070746/202150/Postnatal-Antiretroviral-Prophylaxis-and-Perinatal?redirectedFrom=fulltext?autologincheck=redirected
- https://ryanwhite.hrsa.gov/about/budget
- Kaiser Family Foundation – Medicaid’s Role in HIV
- Center on Budget and Policy Priorities – Work Requirements Impact
- Justice Collaborative – Aging and HIV
- Georgetown University Health Policy Institute – Medicaid and Children’s Health
- CDC – HIV in the U.S.: At A Glance
- HIVMA – Policy Statements
- CDC – Guidelines on Perinatal HIV
- HHS – Ending the HIV Epidemic Strategic Plan
- National Health Law Program – Pregnant Women’s Eligibility
Placeholder Citations (replace for publication):
F. CDC Congenital HIV Surveillance Data
G. NASTAD or state-level budget analysis on pediatric HIV service funding