HIV-Infected Veterans Have Higher Rates of Medicare/Medicaid Enrollment

A substantial proportion of veterans are dually enrolled in the Veterans Affairs (VA) healthcare system as well as Medicare and/or Medicaid, which leads to care received inside and outside of the VA. However, the use of non-VA healthcare among this population can lead to fragmented, inefficient, and lower quality of care.

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In addition, veterans with HIV in this dually covered population may be at greater risk of poor health-related outcomes due to non-VA use. A recent study examined HIV-infected and uninfected populations of veterans to determine healthcare enrollment, usage, and outcomes [BMC Health Services Research. 2015; DOI:10.1186/s12913-015-0684-8].

The study’s objectives were to determine the frequency and factors associated with Medicare and/or Medicaid enrollment and non-VA use in HIV-infected and uninfected veterans and to identify characteristics that predict non-VA hospital admissions among male HIV-infected veterans enrolled with Medicare and/or Medicaid compared with uninfected veterans.

The retrospective, cohort study included both HIV-infected and uninfected veterans in the United States during 2004 and 2005. Data from the Veterans Aging Cohort Study (VACS)—a prospective, observational, cohort study of HIV-infected veterans and age-, race-, and site-matched controls—were used.

The study included veterans enrolled in VACS prior to January 1, 2003, who were engaged in VA care, which was defined as at least 1 inpatient or outpatient visit to a VA medical center in 2003.

The final sample of study participants included 7765 HIV-infected and uninfected male veterans enrolled in fee-for-service Medicare and/or Medicaid.

The study found that HIV-infected veterans engaged in VA care were more likely than uninfected veterans to be enrolled in Medicare and/or Medicaid (38% vs 33%; P<.01). HIV-infected veterans <65 years of age were more likely to be enrolled in Medicare and/or Medicaid than uninfected veterans (36% vs 29%; P<.01). However, HIV-infected veterans ≥65 years of age were less likely to be dually enrolled in Medicare and/or Medicaid (53% vs 70%; P<.01).

The majority of overall veterans with dual coverage were more likely to be enrolled in Medicare, though HIV-infected veterans were more likely than uninfected veterans to be enrolled in Medicaid either alone or in combination with Medicare.

Among veterans dually enrolled with Medicare and/or Medicaid with at least 1 inpatient admission, the frequency of HIV-infected veterans was lower than the frequency among uninfected veterans (48% vs 54%; P<.01).

HIV-infected veterans also had lower odds of hospitalization outside a VA facility (odds ratio, 0.76; 95% confidence interval, 0.68-0.85).

Comparatively, HIV-infected veterans were more likely to be younger and living in closer proximity to VA hospitals.

The study’s authors noted limitations, including the limited access to data on private insurance enrollment and utilization in the VA population. Therefore, some patients classified as having only VA admissions may actually have accounted for admissions to non-VA hospitals.

Though Medicare and/or Medicaid coverage offers a valuable resource for veterans who face higher copayments or live far distances from VA medical centers, this dual enrollment could lead to inefficient care, according to the study’s authors.
The researchers concluded that HIV-infected veterans have complicated medical histories and are likely to experience inefficient care and poor outcomes related to non-VA use.

Further research on “evidence of the cost and health implications of Medicare and/or Medicaid use may help guide the VA in how aggressively to pursue and retain these patients in the VA system,” the authors concluded.—Kerri Fitzgerald