Early evidence from California on transitions to a reformed health insurance system for persons living with HIV/AIDS.

BACKGROUND Many uninsured people living with HIV/AIDS (PLWHA) will obtain managed health insurance coverage when the Affordable Care Act (ACA) is implemented in January 2014. Since 2011, California has transitioned PLWHA to Medicaid managed care (MMC) and to the Low-Income Health Program (LIHP). OBJECTIVES To draw lessons for the ACA implementation from the transitions into MMC and the LIHP. METHODS Surveys about clients and services provided before and after the transition to MMC and the LIHP were sent to 43 HIV service providers. Usable responses were obtained from 18 (42%). RESULTS Although total client loads were similar in the pre- (January 2011) and posttransition periods (June 2012), many clients transitioned from fee-for-service (FFS) Medicaid to MMC. Over this period, responding agencies served 43.5% fewer PLWHA in FFS Medicaid, whereas the share of PLWHA covered by MMC rose from 16.9% to 55.5%. Managed care covered a smaller number of services than either FFS Medicaid or Ryan White sites. Ryan White providers reported that 53% of the clients they served in January 2011 had transitioned to the LIHPs. Nonetheless, they continued to provide services to many of these clients, and Ryan White caseloads did not decline. CONCLUSIONS PLWHA enrolled in the MMC continue to depend on Ryan White sites to supply the full range of services that will allow them to take full advantage of increased access to care under ACA.