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Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system.
Am J Manag Care. 2003 Sep; 9(9):595-602.AJ

Abstract

BACKGROUND

Some experimental Medicaid managed care systems have expanded eligibility criteria for chronically ill persons, but these systems' impact on access to care remains unknown.

OBJECTIVE

To determine whether initiating a statewide Medicaid managed care system (TennCare) guaranteeing universal access for persons living with HIV or AIDS (PLWHs) increased their enrollment in public sector insurance.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective longitudinal descriptive analysis of trends in population characteristics during the study period was performed. The study population included all PLWHs in Tennessee (1992-1997) identified by the State Health Department. These data linked with Medicaid/TennCare enrollment files identified percentages of Tennessee's HIV/AIDS population enrolled in Medicaid (1993) or TennCare (1994-1997) and eligi-bility/demographics changes during program initiation.

MAIN OUTCOME MEASURE

Annual percentage of PLWHs enrolled in Medicaid/TennCare.

RESULTS

Absolute numbers of PLWHs served by Medicaid/TennCare increased 475% from 1992 (n = 593) to 1997 (n = 2818). Similar increases in Tennessee's overall HIV-positive population occurred. Percentages of PLWHs enrolled in Medicaid/TennCare increased (1993 to 1997): HIV (28% to 34%) and AIDS (32% to 44%). The largest percentage of PLWHs added to the program were uninsured/uninsurable.

CONCLUSIONS

Absolute numbers of PLWHs covered by Medicaid/TennCare substantially increased. Percentages of PLWHs covered increased more modestly, partly owing to large increases in overall numbers of HIV-positive Tennesseans during the study period. Increases in coverage were greatest for the AIDS population. Tennessee's broad expansion of eligibility for PLWHs resulted in improved access, but did not result in enrollment of most PLWHs. States contemplating similar Medicaid expansions should not expect all PLWHs to crowd into public sector insurance programs.

Authors+Show Affiliations

Division of General Internal Medicine, Department of Medicine, University of Tennessee Health Science Center, 66 N Pauline, Room 622, Memphis, TN 38105, USA. jeb@utmem.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

14527105

Citation

Bailey, James E., et al. "Improvements in Access to Care for HIV and AIDS in a Statewide Medicaid Managed Care System." The American Journal of Managed Care, vol. 9, no. 9, 2003, pp. 595-602.
Bailey JE, Van Brunt DL, Raffanti SP, et al. Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system. Am J Manag Care. 2003;9(9):595-602.
Bailey, J. E., Van Brunt, D. L., Raffanti, S. P., Long, W. J., & Jenkins, P. H. (2003). Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system. The American Journal of Managed Care, 9(9), 595-602.
Bailey JE, et al. Improvements in Access to Care for HIV and AIDS in a Statewide Medicaid Managed Care System. Am J Manag Care. 2003;9(9):595-602. PubMed PMID: 14527105.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system. AU - Bailey,James E, AU - Van Brunt,David L, AU - Raffanti,Stephen P, AU - Long,Wendy J, AU - Jenkins,Patrick H, PY - 2003/10/7/pubmed PY - 2003/12/3/medline PY - 2003/10/7/entrez SP - 595 EP - 602 JF - The American journal of managed care JO - Am J Manag Care VL - 9 IS - 9 N2 - BACKGROUND: Some experimental Medicaid managed care systems have expanded eligibility criteria for chronically ill persons, but these systems' impact on access to care remains unknown. OBJECTIVE: To determine whether initiating a statewide Medicaid managed care system (TennCare) guaranteeing universal access for persons living with HIV or AIDS (PLWHs) increased their enrollment in public sector insurance. DESIGN, SETTING, AND PARTICIPANTS: A retrospective longitudinal descriptive analysis of trends in population characteristics during the study period was performed. The study population included all PLWHs in Tennessee (1992-1997) identified by the State Health Department. These data linked with Medicaid/TennCare enrollment files identified percentages of Tennessee's HIV/AIDS population enrolled in Medicaid (1993) or TennCare (1994-1997) and eligi-bility/demographics changes during program initiation. MAIN OUTCOME MEASURE: Annual percentage of PLWHs enrolled in Medicaid/TennCare. RESULTS: Absolute numbers of PLWHs served by Medicaid/TennCare increased 475% from 1992 (n = 593) to 1997 (n = 2818). Similar increases in Tennessee's overall HIV-positive population occurred. Percentages of PLWHs enrolled in Medicaid/TennCare increased (1993 to 1997): HIV (28% to 34%) and AIDS (32% to 44%). The largest percentage of PLWHs added to the program were uninsured/uninsurable. CONCLUSIONS: Absolute numbers of PLWHs covered by Medicaid/TennCare substantially increased. Percentages of PLWHs covered increased more modestly, partly owing to large increases in overall numbers of HIV-positive Tennesseans during the study period. Increases in coverage were greatest for the AIDS population. Tennessee's broad expansion of eligibility for PLWHs resulted in improved access, but did not result in enrollment of most PLWHs. States contemplating similar Medicaid expansions should not expect all PLWHs to crowd into public sector insurance programs. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/14527105/Improvements_in_access_to_care_for_HIV_and_AIDS_in_a_statewide_Medicaid_managed_care_system_ L2 - https://www.ajmc.com/pubMed.php?pii=2496 DB - PRIME DP - Unbound Medicine ER -