BBBA, Medicaid Expansion Could Expand Coverage For HIV Community

February 16, 2022 - In states that have not adopted Medicaid expansion, individuals with HIV have limited access to care, but pending legislation and potential future expansions could change those circumstances, a Kaiser Family Foundation (KFF) report found.

“Given high rates of uninsurance among people with HIV in non-expansion states and the prevalence of problems with medical bills, coverage gains could improve health access and affordability,” the resaearchers explained. “And since people with HIV in non-expansion states are disproportionally people of color, new coverage opportunities could also help to address health disparities at the intersection of HIV and race/ethnicity.”

The researchers leveraged data from the Centers for Disease Control’s and Prevention’s (CDC) Medical Monitoring Project (MMP). MMP is a surveillance system that observes behavioral health and clinical conditions of Americans living with HIV. 

The system does not analyze every state, but five of the states in the surveillance system are non-expansion states: Florida, Georgia, Mississippi, North Carolina, and Texas. These states considerable insight into the status of individuals diagnosed with HIV in non-expansion states because they make up the majority of the community with HIV in the non-expansion states (84 percent).

The Build Back Better Act, which passed in the House of Representatives and awaits consideration in the Senate, seeks to expand coverage for non-elderly adults with HIV who have incomes below 139 percent of the federal poverty level. If passed, the law would expire in 2025.

The Build Back Better Act would expand healthcare coverage access for nearly a quarter of non-elderly Americans with HIV in the five states that have not adopted Medicaid expansion (23 percent).

This legislation would increase access by providing subsidies and cost-sharing assistance to lower-income residents, which would apply to 16 percent of the communities living with HIV in the five non-expansion states. Those who are eligible for this provision would receive free coverage and low cost-sharing. 

Another seven percent of low-income individuals in a slightly higher income bracket would receive enhanced subsidies.

These advantages would primarily impact people of color and the uninsured. Almost nine out of ten individuals living with HIV who would qualify for these benefits (86 percent) are non-white and over half of this group is Black or African American (55 percent).

Almost six in ten of the individuals who would be impacted are uninsured and 26 percent have private insurance.

Individuals with HIV in non-expansion states have a harder time paying their medical bills, compared to all individuals with the same diagnosis. In non-expansion states, people with HIV are more likely to have unpaid medical bills, skip or decrease treatment doses due to cost-related concerns, or delay filling prescriptions to reap cost savings.

The legislation could also have an impact on the resources of key programs that support the community of individuals with HIV. 

Most of the individuals who might receive coverage or cost support from the Build Back Better Act are also in the Ryan White HIV/AIDS program. By increasing financial support for the community, the Ryan White program could channel its funds toward expanding its support in other areas, the researchers argued.

The law would impact states without Medicaid expansion to varying degrees, expanding access to coverage for only 18 percent of the population with HIV in North Carolina and Georgia and as much as 28 percent of the population in Texas.

Work requirements and prior authorizations have proven to be barriers to coverage for the HIV community, but Medicaid expansion and the Build Back Better Act could create better coverage options for them, the KFF report indicated. Medicaid expansion can also help identify undiagnosed HIV infections.