Enrolling Uninsured Minority Individuals Living with HIV into New Insurance Options under the Affordable Care Act (ACA): A Nationwide Ryan White HIV/AIDS Program Grantee Needs Assessment

Background: The ACA seeks to reduce the number of uninsured individuals including those with chronic diseases like HIV.  Racial/ethnic minorities living with HIV are uninsured at higher rates than whites living with HIV and are disproportionately served by the Ryan White HIV/AIDS Program (RWHAP). Under ACA, people living with HIV can access health insurance including both Marketplace and Medicaid options. This study assessed the current capacity and readiness of RWHAP grantees to conduct outreach/enrollment into ACA options.

Methods: A structured grantee needs assessment (NA) was developed to explore policy, enrollment capacity and cultural competency. Over 500 RWHAP grantees plus many more subgrantees were invited to complete the web-based NA tool. Results were analyzed using SAS v.9.3 and stratified by Medicaid expansion status; type of Marketplace; grantee type; and enrollment and post-enrollment capacity score. Follow-up qualitative interviews were also conducted with selected respondents.

Results: There were 231 competed responses, 87% from organizations providing direct services to clients. Thirty-one percent received additional funds to support outreach/enrollment. Respondents in states with state-run Marketplaces had higher enrollment capacity than respondents in states using the federal Marketplace. Respondents in states with Medicaid expansion had higher enrollment capacity than respondents in states without Medicaid expansion

Conclusions:  Many RHWAP grantees have limited knowledge of ACA coverage options, and limited experience enrolling clients in health insurance. These data suggest that increasing the enrollment of minority PLWH into expanded ACA insurance will require culturally/linguistically appropriate education, materials, training and technical assistance.