The COVID-19 pandemic posed challenges to chronic condition management, including HIV. However, innovations were implemented in the US to minimize care disruptions for people with HIV (PWH), including telehealth and longer antiretroviral therapy (ART) prescriptions. Further data are needed on the impact of the pandemic on HIV care in diverse nationwide samples. We analyzed Medicaid claims data from 24 US states and DC. We included 87,015 PWH who were enrolled for the 18 months prior to March 2020. We followed beneficiaries through September 2021, death, age 65, or loss of Medicaid eligibility. We examined whether the monthly prevalence of ART adherence and rates of routine care visits (overall, in-person, telehealth) and of HIV laboratory tests (i.e., CD4 cell count, HIV viral load) differed before vs. during COVID using Bayesian structural time series models. To inform the prediction of the counterfactual where the pandemic did not occur, we accounted for a control sample of PWH who were followed September 2016-September 2019; we used odds weights to standardize the distribution of age, sex, race, state, and number of Charlson comorbidities to that seen in the main sample in March 2020. In both samples, we used inverse probability of censoring weights to account for informative censoring. In the initial months following March 2020 (Figure), we saw a modest bump in prevalence of ART adherence, a large decrease in rates of in-person visits and lab tests, and a large increase in rates of telehealth visits. Rates of lab tests returned to pre-COVID rates 12 months after the pandemic. While in-person office visits did not return to the pre-COVID rates by 18 months, the decrease was offset by the increase in telehealth visits, in all months except March-May 2020. Frequency of engaging in care among PWH in Medicaid was not severely negatively impacted by COVID, in part due to the uptake of telehealth; however, lingering questions remain on the impact on quality of care.