The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #65677

Richard Conviser, PhD, Chief, Service Evaluation and Research Branch - HRSA, Office of Science and Epidemiology, HIV/AIDS Bureau, 5600 Fishers Lane, Rm 7C07, Rockville, MD 20857, 301-443-3075, rconviser@hrsa.gov, Gregory Fant, PhD, HIV/AIDS Bureau, Office of Science and Epidemiology, Health Resources and Services Administration, Parklawn Bldg., Rm. 7-90, 5600 Fishers Lane, Rockville, MD 20857, and Jaclyn Chu, BS, Bloomberg School of Public Health, Johns Hopkins University, PO Box 385, 615 N. Wolfe St, Baltimore, MD 21205.

CARE Act programs are intended to be funders of last resort for HIV/AIDS services in the U.S. The major contexts within which they operate are State Medicaid programs, whose features vary substantially. This study examines the correlation of State Medicaid program features with CARE Act allocations (expressed as proportions of total discretionary Title I and II dollars) for health and medical care in 1999 and 2000. Discretionary CARE Act Title I and II expenditures for health care services varied across the States from 0%-64%, and expenditures for medical (outpatient and ambulatory) services, from 0%-36%. Medicaid features examined included Federal matching rate (a poverty index), the presence of specific HIV programs (targeted case management or home- and community-based care waivers), the presence of managed care waivers, and the presence of Medically Needy programs allowing residents to qualify for Medicaid by subtracting their medical expenditures from their total incomes. Control variables included total Title I and II allocations in each State and total funds received by each State’s Title III early intervention programs. Logistic multiple regression analyses showed that the presence of Medically Needy programs correlated inversely with 1999 CARE Act health services expenditures, and the presence of specific HIV programs correlated inversely with 2000 medical services expenditures. Conclusion: State Medicaid program limitations may require that CARE Act dollars be spent for medical and health services, precluding their use for housing, emergency financial assistance, and other supportive services that may be necessary for program participants to become adherent to HIV care regimens.

Learning Objectives:

The participant in this session will learn
• that there is substantial variability in the proportion of Ryan White CARE Act Title I and II funds that each State allocates for medical and health care services, as opposed to case management and support services,
• that State Medicaid programs have optional features that may be associated with better access to HIV primary care services, including Section 1115 managed care waivers, Medically Needy programs, and HIV-specific programs such as targeted case management and Section 1915c home- and community-based care waivers, and
• which of these State Medicaid program features are associated with CARE Act expenditures on medical and health care services, and the policy implications of these findings.

Keywords: HIV/AIDS, Ryan White

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.