Here is the update and what fixed it for me.
NOTE3: If you have recently updated to Mac OS Catalina (10.15.x), Mac OS Big Sur (11.00.x), or Mac OS Monterrey (12.00.x) you need to re-enable the built in Smart Card ability after removing all installed enablers listed above:
1. Remove your CAC from the reader
2. Open Terminal, by typing Terminal in the spotlight search
3. Copy the entire command below [starting with sudo, and ending with pivtoken] and paste it into the terminal window (or manually retype it)
sudo defaults write /Library/Preferences/com.apple.security.smartcard DisabledTokens -array && sudo defaults write /Library/Preferences/com.apple.security.smartcard EnabledTokens -array com.apple.CryptoTokenKit.pivtoken
3a. When prompted for your computer password, know that the cursor will not move, type it in, and hit enter to process
4. It is recommended you do the command again after this...no password will be prompted
5. After performing these steps, the built in smart card ability should be enabled (it should actually say that in terminal that it was re-enabled).
6. Logout of Terminal,
7. Restart computer
I was using VMware Horizon and it prompted the certificate immediately which is all I needed.