More than a million Americans live with HIV. And about 40% of those adults are currently enrolled in Medicaid. But that might not be true for much longer.

Beginning next year, the federal government will require Medicaid enrollees who qualified through the Affordable Care Act's expansion program and are living near the poverty level to document that they're either working, in school or participating in community service to continue receiving coverage. The law that created those work requirements wisely created exemptions for groups of people such as caregivers, pregnant women, people who are disabled or those with substance use or mental health disorders. Additionally, there is an exemption for people with serious or complex medical conditions. However, there was no specific definition of those medical conditions.

Congress left it up to the law's implementers to decide who qualifies as having a serious or complex medical condition. We are currently waiting for administrators in the federal government to provide guidance about which specific conditions and diseases qualify for those exemptions. If they do not, states will be left to decide on their own. That is a risk people living with HIV can't take.

HIV is a lifelong, serious and complex medical condition. People may be living longer and managing their disease better today -- but only if they have access to antiretroviral medications, skilled providers, case managers, and services to support treatment adherence. All of these fundamental supports are provided by Medicaid.

HIV should be one of the medical conditions that warrants an exemption by the federal government. If it isn't, according to estimates from KFF, over 145,000 people living with HIV would lose insurance coverage if they don't qualify for one of the exemptions. That wouldn't just interrupt many patients' treatment regimens but put their lives in danger. It'd also greatly increase the risk of new HIV transmissions, resulting in far greater public health spending in the long run.

That would severely undermine the progress we've made against HIV. Domestically, new cases have been dropping: New infections declined by 12% between 2018 and 2022.

But we still have a long way to go. In addition to the 1.2 million Americans living with HIV, tens of thousands are still diagnosed with it annually.

That's why federal officials ought to make it abundantly clear that Americans living with HIV are precisely the sorts of people that Congress had in mind when it created an exemption to work requirements.

Carl Schmid is executive director of the HIV+Hepatitis Policy Institute. This piece originally ran in U.S. News and World Report.