title: Early evidence from California on transitions to a reformed health insurance system for persons living with HIV/AIDS.
abstract: 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).
  
  
  OBJECTIVE
  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.
authors.affiliation: *Department of Public Policy, UCLA Luskin School of Public Affairs, Los Angeles, CA; †AIDS Project Los Angeles, Los Angeles, CA; ‡Los Angeles Gay and Lesbian Center, Los Angeles, CA.
authors.forename: Arleen A
authors.initials: AA
authors.lastname: Leibowitz
authors.forename: Robbie
authors.initials: R
authors.lastname: Lester
authors.forename: Philip G
authors.initials: PG
authors.lastname: Curtis
authors.forename: Kevin
authors.initials: K
authors.lastname: Farrell
authors.forename: Aaron
authors.initials: A
authors.lastname: Fox
authors.forename: Luke H
authors.initials: LH
authors.lastname: Klipp
authors.forename: Jason
authors.initials: J
authors.lastname: Wise
mesh_terms: D002140:California; D003625:Data Collection; D018588:Fee-for-Service Plans; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000628:therapy; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D008297:Male; D008329:Managed Care Programs / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D058991:Patient Protection and Affordable Care Act / Q000706:statistics & numerical data*; D014481:United States