Early Evidence From California on Transitions to a Reformed Health Insurance System for Persons Living With HIV/AIDS

Abstract

Background Many uninsured people living with HIV/AIDS (PLWHA) will obtain managed health insurance coverage when the Affordable Care Act (ACA) is implemented in January 2014. Since 2011, California has transitioned PLWHA to Medicaid managed care (MMC) and to the Low Income Health Program (LIHP). Objectives To draw lessons for the ACA implementation from the transitions into MMC and the LIHP. Methods Surveys about clients and services provided before and after the transition to MMC and the LIHP were sent to 43 HIV service providers. Usable responses were obtained from 18 (42%). Results Although total client loads were similar in the pre- (January 2011) and post- transition periods (June 2012), many clients transitioned from fee-for-service (FFS) Medicaid to MMC. Over this period, responding agencies served 43.5% fewer PLWHA in FFS Medicaid while the share of PLWHA covered by MMC rose from 16.9% to 55.5%. Managed care covered a smaller number of services than either FFS Medicaid or Ryan White sites. Ryan White providers reported that 53% of the clients they served in January 2011 had transitioned to the LIHPs. Nonetheless, they continued to provide services to many of these clients and Ryan White cases loads did not decline. Conclusions PLWHA enrolled in Medicaid managed care continue to depend on Ryan White sites to supply the full range of services that will allow them to take full advantage of increased access to care under ACA.

HIV Testing, Care, and Treatment Among Women Who Use Drugs From a Global Perspective

“…The Ryan White HIV/AIDS Program (a payer of last resort) ensures that all HIV-positive persons have access to HIV care, though its future remains unclear as individuals transition to the expanded system under the ACA or to private insurance. 51 …”

Transitioning From Medicaid Disability Coverage to Long-Term Medicare Coverage: The Case of People Living With HIV/AIDS in California

“…Many PLWHA who obtained care at Ryan White sites prior to ACA implementation were required to move either to Medicaid or to Insurance Exchange plans. These plans provide more limited access to mental health and substance use treatment than the Ryan White program, which provides to uninsured and underinsured PLWHA a comprehensive range of services that are not provided by any other source (Cahill, Mayer, & Boswell, 2015; Leibowitz et al, 2013). Thus, PLWHA may need to depend on either community providers or wrap-around services from the Ryan White program to support continued engagement in care with the goal of viral suppression (Arns et al, 2004; Cahill et al, 2015; Gonzalez et al, 2011; Holtzman et al, 2015; Huynh et al, 2013; Lucas, 2011; Magidson et al, 2015; Turan et al, 2016).…”

Addressing the Challenges of the HIV Continuum of Care in High-Prevalence Cities in the United States

“…3 An initial round of funding (ECHPP-1) was awarded in September 2011 to support CFAR investigators in the nine highest AIDS prevalence cities in the U.S. (Atlanta, Chicago, Houston, Los Angeles, Miami, New York City, Philadelphia, San Francisco and Washington, DC) to conduct research on HIV prevention and care interventions in support of the CDC ECHPP initiative. In a previous supplemental issue of JAIDS published in November 2013, 8 results from these studies were presented on HIV testing, 29–30 linkage to care, retention and re-engagement in care, maximizing viral suppression 31–33 , HIV health service provision 34–36 and non-occupational post-exposure prophylaxis. 37 …”