July 16, 2024
Medicaid is the single largest source of financing for HIV care in the United States
Brief articulates policy recommendations for federal and state Medicaid officials to bring us closer to ending the HIV epidemic with game-changing longer-acting medication
WASHINGTON, D.C. — Today, the O’Neill Institute for National and Global Health Law at Georgetown University Law Center, in partnership with Amida Care and Cicatelli Associates (CAI) TAP-in project, released a policy brief calling on Medicaid officials at the federal and state levels to take crucial steps to harness the potential of breakthrough longer-acting products for HIV prevention and treatment. The “Big Ideas” brief outlines concrete strategies for federal and state Medicaid leadership to capitalize on the game-changing promise of longer-acting products, with a focus on prioritizing access for those who are covered by Medicaid, representing populations most deeply impacted by HIV.
“Medicaid — the largest payor for HIV care in the United States — has an opportunity to leverage exciting new treatment and prevention options that can increase use, adherence, and persistence,” said Jeffrey S. Crowley, director of the Center for HIV and Infectious Disease Policy at the O’Neill Institute. “At the federal and state levels, Medicaid leaders must be called upon to enforce the law and draw upon the policy levers at their disposal to provide consistent and reliable access to these potentially transformative new products.”
The brief includes several policy recommendations, including:
- Federal leadership should articulate a roadmap for integration of longer-acting therapies for HIV treatment and prevention
- The Centers for Medicare & Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) partners should develop a comprehensive update to their 2016 Informational Bulletin on HIV prevention and care delivery
- CMS should issue policy guidance on Medicaid’s role in supporting uptake and persistence of pre-exposure prophylaxis (PrEP) use to prevent new HIV cases
- CMS should designate an official in the Administrator’s office to coordinate HIV policy and increase collaboration with other parts of HHS
- States should create a level playing field for plans, as well as support delivery system transformation and reforms
- State Medicaid programs should revisit managed care contract standards to support longer-acting treatment implementation
- State Medicaid programs should ensure access to all covered anti-retroviral (ART) medications across health plans
Forty percent of adults under age 65 living with HIV receive their care through Medicaid, making it the single largest source of HIV coverage in the United States. As a country, the United States has made incredible strides toward the goal of ending the HIV epidemic. However, progress has been uneven and unacceptable inequities remain. Factors, such as poverty, lack of transportation, limited English proficiency, and experiences of discrimination in health care settings — all common among Medicaid beneficiary communities, particularly LGBTQ+ communities and communities of color — regularly undermine engagement to prevention and treatment efforts.
Pre-exposure prophylaxis is a game-changing HIV prevention medication that has been available for over a decade, yet PrEP uptake is lower among those who are covered by Medicaid than those who have private insurance. Systemic barriers disproportionately impact Black, Latinx, and transgender communities, who are more likely to be Medicaid-eligible. These communities often experience multiple barriers to care, resulting in reduced access to and utilization of PrEP compared to their white counterparts and exacerbating health disparities.
By reducing pill burden and stigma, longer-acting products present a unique opportunity to rectify long-standing inequities in both prevention and treatment, but only if Medicaid leaders at both the federal and state levels make the necessary changes to ensure appropriate access. Crucially, to move from regimens that are available via pharmacy pick-ups to ones that may require office visits and provider administration will necessitate greater understanding of coverage requirements, beneficiary protections, and the utmost flexibility so that states can develop the infrastructure and processes that work best for them and the communities most deeply impacted by HIV.
“We are proud to partner with the O’Neill Institute and CAI to develop this Brief outlining the key steps Medicaid must take to move us ever closer to ending the HIV epidemic,” said Doug Wirth, CEO of Amida Care, a Medicaid Special Needs Health Plan specifically designed for people affected by HIV. “We can’t end the HIV epidemic without focusing on Medicaid. By prioritizing those who rely on Medicaid, we can move forward with intention to prevent systemic barriers and ensure that longer-acting products reach those individuals who will benefit from them the most.”
“We are proud to be a partner with the O’Neill Institute and Amida Care in producing this Brief that speaks to policy makers at the federal, state and local levels,” said William Murphy, chief of strategic initiatives at CAI, a capacity building organization that is also the national End the HIV Epidemic Technical Assistance Provider for HRSA HAB. “Accelerating the availability of longer acting products and improving HIV prevention and treatment options for populations who have lacked equitable access, such as cisgender Black women, is key to ending the epidemic.”
About O’Neill Institute for National and Global Health Law
Housed at Georgetown Law in Washington, D.C., the O’Neill Institute for National and Global Health Law brings together leading experts to reflect on the importance of public and private law in health policy analysis and engage policymakers, academics, and journalists with research and advocacy to end pandemics, ensure human rights, and advance the right to health in the United States and around the world. This project is a product of the Longer-Acting Policy Project which receives support from Gilead Sciences, Merck, and ViiV Healthcare. For more information about the O’Neill Institute, visit oneill.law.georgetown.edu. Follow the O’Neill Institute on X at @oneillinstitute and on LinkedIn for the latest updates in health law.
About Amida Care
Amida Care Inc. is a not-for-profit health plan that specializes in providing comprehensive health coverage and coordinated care to New Yorkers with complex conditions, including HIV and behavioral health disorders, and people who are of transgender experience or who are homeless (regardless of HIV status). Amida Care has a wide network of health care providers throughout New York City and is the largest Medicaid Special Needs Health Plan (SNP) in New York State. For more information, visit www.amidacareny.org.
About CAI
CAI helps organizations improve the quality of their services, particularly for communities that have been marginalized. We do this by providing tailored training and technical assistance, peer learning collaboratives and other capacity building support. Our mission is to use the transformative power of education and research to foster a more aware, healthy, compassionate and equitable world. If you would like to learn about how we can work together, visit: www.caiglobal.org.