Report: States Can Improve HIV Care Through Medicaid, Ryan White Program Collaboration

Through their Medicaid and Ryan White HIV/AIDS Programs, states play an integral role in ensuring access to care for people living with HIV. In a 3-part series, the National Academy for State Health Policy explored how states can use policy levers to more effectively utilize limited resources and provide better care, improve care coordination services, and ensure consistent access to care for people living with HIV.

Read more on improving care for people living with HIV.

Collaboration between the 2 programs is crucial and can help states minimize duplication and fragmentation of services and ensure that resources are used more effectively, the authors of the series argue.

Improving collaboration between Medicaid and AIDS Drug Assistance Programs

Similar to Medicaid, the Ryan White HIV/AIDS Program serves low-income people, providing medical care, prescription drugs, and supportive services for people living with HIV.

A major component of the Ryan White HIV/AIDS Program is the AIDS Drug Assistance Programs, which provides a safety net for those not eligible for Medicaid by offering prescription drugs, as well as assistance with health insurance premiums and drug cost-sharing.

The report outlines 4 opportunities for Medicaid and Ryan White HIV/AIDS rograms to identify and address barriers at the intersection of the 2 programs:

• Review alignment of prescription drugs available across Medicaid and AIDS Drug Assistance Programs and ensure access to consistent antiretroviral therapy medications even as eligibility fluctuates between the 2 programs
• Establish systems to prevent duplicate rebates or discounts on prescriptions drugs
• Identify common barriers to accessing necessary medications, such as prior authorization
• Create systems to coordinate verification of eligibility and avoid duplication of services by leveraging Medicaid systems and streamlining eligibility determinations

Improving care coordination services

“Care coordination can be an important tool for states to increase rates of virologic suppression by helping people living with HIV access and maintain treatment, stay engaged in care, and address other needs such as housing, nutrition, transportation, and behavioral health services,” wrote the authors of the report.

Benefits of collaboration between the 2 programs will transfer over into care coordination, they explained. As both programs offer care coordination services, states must avoid the duplication of services to patients who may qualify for both programs or switch between the 2 based on eligibility. By doing this, the authors contended, state policy makers will be able to maximize limited resources.

In order to ensure access to physical and behavioral health, they recommended:

• Facilitating cross-agency care and service delivery by specialized HIV providers and service organizations through managed care contracting, health homes, and Section 1915(c) Home and Community Based Services waivers, which allow states to develop specialized benefits for a target population
• Using data to link individuals to services and reduce duplications
• Aligning training for care coordinators across the Medicaid and Ryan White HIV/AIDS programs

Coordinating eligibility between Medicaid and Ryan White programs

States have a number of factors to consider when structuring eligibility in order to support consistent access to care, such as whether the state has expanded its Medicaid program and how to leverage waiver authorities and managed care to support consistent enrollment.

States also have to decide how Medicaid and Ryan White HIV/AIDS Program grantees can work together to reduce “churning” between programs and minimize coverage disruptions for people living with HIV.

As the 2 programs share a mutual interest in ensuring coordinated and efficient eligibility processes are in place, the authors recommend 4 strategies:

• Explore how Medicaid waiver authorities can better support this population through Section 1915(c) waivers and Section 1115 waivers, which aim to provide low-income people living with HIV with improved access to high-quality, cost effective care
• Engage Medicaid and Ryan White HIV/AIDS Program officials and people living with HIV when planning for changes in health insurance landscapes
• Support policies that minimize coverage disruption
• Share eligibility information across Medicaid and the Ryan White HIV/AIDS Program