Medicaid Leadership Must Ensure Access to Longer-Acting HIV Products

Medicaid always has been the largest source of financing for HIV care in the United States, covering an estimated 40% of non-elderly adults with HIV. People with HIV, however, account for fewer than 1% of Medicaid beneficiaries and less than 2% of federal Medicaid spending. While Medicaid covers a significant share of people with HIV, federal Medicaid policymakers and many state Medicaid officials may not be sufficiently focused on the unique needs of people with and vulnerable to HIV, may not stay abreast of changing HIV clinical practices, and may not understand the importance of focusing attention on HIV services and issues in the face of other, larger Medicaid constituencies. Further, progress toward improving population-level HIV viral suppression also may lead to an impression that HIV prevention and care is not in need of greater policy attention. HIV prevention and care outcomes, however, frequently have been found to be worse in Medicaid than for persons with private insurance. There is also a broad array of factors such as poverty, lack of transportation, limited English proficiency, and experiences of
discrimination and marginalization that are common among Medicaid beneficiary populations that undermine engagement in care, adherence to prevention and treatment, and good health outcomes. States have varied in their commitment to addressing and reducing barriers to adherence to care and good health outcomes. Advances in HIV clinical practices with the development of longer-acting (LA) products for HIV treatment and prevention could be transformative and could lead to more durable viral suppression, improved health outcomes, and fewer HIV cases. Unless Medicaid programs adapt and respond to these developments, however, the opportunity they provide will be missed.

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