Opinion: Medicaid-Funded Care Saves and Rebuilds Lives  – City Limits

“Today, Medicaid is under increasing threat of reductions that would put health care out of reach of thousands of people. Those living with or at risk for HIV would feel the impact first and hardest.”

For more than 25 years I have cared for New Yorkers facing complex health challenges as their nurse practitioner. I have seen firsthand how Medicaid-funded coordinated care that prioritizes prevention and the whole patient can be both life-saving and cost-efficient. 

Today, Medicaid is under increasing threat of reductions that would put health care out of reach of thousands of people. Those living with or at risk for HIV would feel the impact first and hardest, because Medicaid pays for the bulk of HIV care in the U.S.—and HIV rates are climbing again after years of decline.

I have a front-row seat to what’s at risk. Many clinic visits start with me reassuring patients that they won’t lose their benefits before they can get the treatments I recommend. Even in New York, where Gov. Kathy Hochul’s proposed budget invests an additional $4 billion in Medicaid, we don’t know what the future will bring, as the federal HR1 bill and pressures on the Affordable Care Act threaten to shift enormous costs onto states. HR1

So many lives have benefited greatly from whole-person care that includes HIV care, gender-affirming care, primary care, pharmacists, and connections to social services through a Medicaid-funded Special Needs Plan or SNP. Let me introduce just a few of them:

Virginia and Nicole live in Manhattan’s Washington Heights and the Bronx, respectively. Both have been living with HIV for more than 10 years and both now have consistently suppressed viral loads. But both also live with co-morbidities like kidney disease, heart disease, and diabetes that need specialized and coordinated care and support. Their SNP helps with everything from scheduling medical appointments to getting to them. 

Kevin was a hospital social worker in his 30s when his HIV test came back positive. Trauma, stigma, and shame were followed by a crystal meth addiction, job loss, and trouble managing his HIV. His SNP helped with reminders and incentives to take his medications and go to check-ups, and with substance-use treatment. Today, Kevin lives in an apartment in the Bronx. His HIV is undetectable, he is sober, he helps others adhere to HIV treatment, and he advocates to protect Medicaid and HIV funding.

When Anthony was diagnosed with HIV over 20 years ago, he became depressed and suicidal. He says: “I was sick, scared, and alone, going through the New York City shelter system and sleeping in subway cars with basically nothing.” Empathetic and specialized doctors and pharmacists helped him manage his HIV as well as his diabetes and high blood pressure. Today, Anthony’s health has stabilized, he lives in his own apartment in the Bronx, and he advocates for HIV awareness and Medicaid support. He says: “The federal administration is attacking the most vulnerable people, and we don’t have anywhere to turn.”

Shauna knew she was transgender at age 13. This was before Medicaid covered gender-affirming treatment—so she paid for unlicensed surgeries in the U.S. and Mexico that 10 years later made her seriously ill. When she was finally able to see a trans-health specialist, they discovered her breast implants were leaking toxic substances and the silicone in her hips risked causing life-threatening problems. Today, Shauna is healthy and regularly travels from the Bronx to Albany to promote awareness of trans health and the importance of protecting and expanding Medicaid. She says: “My experience is not unique. Transgender people, especially youth, often face discrimination from medical providers and harassment in healthcare settings.”

Medicaid has helped these five people, and so many more, access empathetic, knowledgeable, and holistic health care. Protecting Medicaid helps all of us live better, fuller lives. 

Eric Leach-Rodriguez is a nurse practitioner who focuses on LGBTQ+ health. He cares for New Yorkers who are Amida Care members as well as patients of a midtown Manhattan community health center.