Medicaid expansion states report improved HIV care in ACA era
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The ability to provide high-quality care improved for HIV providers in Medicaid expansion states following implementation of the Affordable Care Act in 2014, according to survey results published in Open Forum Infectious Diseases.
“Our team conducted a study about national HIV clinicians’ knowledge of, and attitudes about, the Affordable Care Act (ACA) in 2015,” Kathleen A. McManus, MD, MSCR, associate program director of the infectious diseases fellowship program and assistant professor in the division of infectious diseases and international health at the University of Virginia, told Healio. “Despite generally good knowledge about the ACA, there were gaps. Three years later, we aimed to evaluate HIV clinicians’ attitudes about the ACA’s impact on the quality of HIV care that they can deliver and on barriers to engagement in HIV care. We also characterized changes in HIV clinicians’ knowledge.”
McManus and colleagues emailed HIV clinicians a survey weblink between March 2018 and July 2018. They obtained demographic information, including age, type of clinician, length of time providing HIV care, political affiliation and primary state where the clinician practices HIV medicine. The researchers asked participants to pinpoint all major sources of knowledge about the ACA, including other individuals, various types of media and the law itself.
According to the study, of the 211 survey participants, the majority (70%) answered all four knowledge questions correctly; about 80% of respondents knew whether or not their state had expanded Medicaid. Participants from Medicaid expansion states were more likely to report an improved ability to provide high-quality care compared with participants from states that did not expand Medicaid (50% vs. 34%; P = 0.01). The researchers also found that the average response to whether the ACA addresses the main barriers to HIV care was neutral and did not differ based on Medicaid status. The top three barriers to HIV care included mental health, substance use and transportation.
According to McManus, approximately 80% of participants knew whether or not their state had expanded Medicaid, representing an improvement from 70% in 2015.
“After the full ACA implementation in 2014, HIV clinicians in Medicaid expansion states were more likely to report an improved ability to provide high-quality care compared with those in Medicaid nonexpansion states.” McManus said. “However, HIV clinicians across the United States are concerned that the ACA does not address the main barriers to HIV care, which they identified as mental health, substance use and transportation. The Federal Ending the HIV Epidemic initiative can address these identified barriers.”
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