Despite Challenges, Medicaid Viewed Positively by New Enrollees With HIV

Although their perceptions of Medicaid were mostly positive, all surveyed people with human immunodeficiency virus (HIV) newly enrolled in Medicaid in Virginia reported difficulty understanding insurance-related information, according to study findings published online ahead of print in AIDS Research and Human Retroviruses.

“Most felt that their own health improved after Medicaid enrollment and that Medicaid allowed people with HIV to have good care,” wrote researchers from the University of Virginia in Charlottesville. “Even with enrollment help, participants voiced that dealing with insurance is hard. This might have important consequences and may be why a quarter of participants self-reported a detectable viral load in the first year on Medicaid.”

To better understand patient experiences with Medicaid, researchers interviewed 28 patients with HIV who, due to Medicaid expansion, transitioned to Medicaid in 2019. Participants were patients at a Ryan White HIV/AIDS Program clinic at the University of Virginia.

Participants reported positive feelings toward Medicaid both before enrollment (68% had positive perceptions in general, 67% specifically for HIV care) and after enrollment (93% in general, 93% for HIV care), according to the study. Patients mentioned care affordability, access to HIV care and other medical and dental care, access to HIV and nonHIV medication, and transportation assistance.

However, to enroll in Medicaid, four out of five patients needed outside help. Afterward, more than 40% experienced overlaps of Medicaid with other insurance/payers or gaps in insurance coverage during the transition from one insurance/payer (such as AIDS Drug Assistance Program medication provision and subsidized insurance) to Medicaid.

“While an overlap might not seem like as big of an issue as a gap, we have heard from insurance assisters that both overlaps and gaps can result in lack of access to medications, including HIV medications,” researchers wrote. “We hypothesize that these overlap and gap issues described by this cohort may be the reason for the lower viral suppression among people with HIV who transitioned to Medicaid in 2019, which was observed in our clinic's quantitative study.”

For a better Medicaid experience, participants suggested better access to information, smoother processes, and less burdensome enrollment measures.

Reference:
McManus KA, Schurman E, An Z, Van Hook R, Keim-Malpass J, Flickinger TE. Patient perspective of people with HIV who gained Medicaid through Medicaid expansion: a cross-sectional qualitative study. AIDS Res Hum Retroviruses. 2021 Oct 18. doi:10.1089/AID.2021.0129