Healthcare Coverage for HIV Provider Visits before and after Implementation of the Affordable Care Act.

Berry SA1, Fleishman JA2, Yehia BR1, Cheever LW3, Hauck H3, Korthuis PT1, Mathews WC1, Keruly J1, Nijhawan AE1, Agwu AL4, Somboonwit C1, Moore RD1, Gebo KA1; HIV Research Network.

Abstract

BACKGROUND:

Prior to Affordable Care Act (ACA) implementation in 2014, 100,000 persons living with HIV (PLWH) lacked healthcarecoverage and relied on a safety net of Ryan White HIV/AIDS Program support, local charities, or uncompensated care (RWHAP/Uncomp) to covervisits to HIV providers. We compared HIV provider coverage pre (2011-2013) versus post (first half of 2014) ACA among a total of 28,374 PLWH followed in 4 sites in Medicaid expansion states (CA, OR, MD), 4 in a state (NY) that expanded Medicaid in 2001, and 2 in non-expansion states (TX, FL).

METHODS:

Multivariate multinomial logistic models assessed changes in RWHAP/Uncomp, Medicaid, and private insurance coverage using Medicare as a referent.

RESULTS:

In expansion state sites, RWHAP/Uncomp coverage decreased (unadjusted, 28% pre-ACA and 13% post-ACA; adjusted relative risk ratio (ARRR) 0.44 [0.40, 0.48]). Medicaid coverage increased (23% and 38%; ARRR 1.82 [1.70, 1.94]), and private coverage was unchanged (21% and 19%; ARRR 0.96 [0.89, 1.03]). In NY sites, both RWHAP/Uncomp (20% and 19%) and Medicaid (50% and 50%) were unchanged, while private decreased (13% and 12%; ARRR 0.86 [0.80, 0.92]). In non-expansion state sites, RWHAP/Uncomp (57% and 52%) and Medicaid (18% and 18%) were unchanged, while private increased (4% and 7%; ARRR 1.79 [1.62, 1.99]).

CONCLUSIONS:

In expansion state sites, half of PLWH relying on RWHAP/Uncomp shifted to Medicaid, while in NY and non-expansion state sites, reliance on RWHAP/Uncomp remained constant. In the first half of 2014, the ACA did not eliminate the need for RWHAP safety net providervisit coverage.