Improvements in access to care for HIV and AIDS in a statewide Medicaid managed care system.
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.


METHODS
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.


METHODS
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.
Bailey
James E
JE
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.edu
Van Brunt
David L
DL
Raffanti
Stephen P
SP
Long
Wendy J
WJ
Jenkins
Patrick H
PH
D000293:Adolescent; D000328:Adult; D004608:Eligibility Determination / Q000639:trends; D005260:Female; D015658:HIV Infections / Q000191:economics* / Q000628:therapy*; D006297:Health Services Accessibility / Q000639:trends*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D008484:Medicaid / Q000592:standards* / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D040442:Public Health Informatics; D012189:Retrospective Studies; D013221:State Health Plans / Q000592:standards* / Q000706:statistics & numerical data; D013714:Tennessee; D017749:Total Quality Management; D014481:United States