Continuous Medicaid Coverage Essential for People Living With HIV

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The strongest association with viral suppression after Medicaid gap was viral suppression before Medicaid gap.
The strongest association with viral suppression after Medicaid gap was viral suppression before Medicaid gap.

Implementing initiatives to maintain Medicaid enrollment and expedite re-enrollment and having alternate resources available during gap times may be important to ensure continuous antiretroviral therapy (ART) to optimize HIV outcomes, according to a study recently published in the Journal of Acquired Immune Deficiency Syndromes.

Medicaid disenrollment is common among adults in the general population, occurring in more than half of enrolled adults within 2 years of enrollment. There is limited research examining the clinical effect of gaps in healthcare coverage, especially lapses in Medicaid among people with HIV. 

This study evaluated the effect of gaps in Medicaid enrollment on viral suppression within the HIV Research Network (HIVRN) by examining viral suppression before and after a gap in Medicaid enrollment.

Researchers used a dataset that captured Medicaid enrollment information and HIVRN clinical data. The primary objectives were to identify and describe characteristics of individuals who had a gap in Medicaid enrollment and evaluate characteristics associated with unsuppressed HIV-1 RNA at the end of a gap, which may suggest failure to access another source of coverage for antiretroviral therapy during the Medicaid gap. 

A total of 5836 patients were included. The majority of participants were male (67%), black (58%), age 25 to 50 years, and from New York (57%). For each month of each year, it was determined whether each individual was enrolled or not enrolled using the personal summary Medicaid Analytic Extract file. A patient was counted as enrolled for an entire month if there were at least 10 days of coverage within that month. Of those with a gap (n=3362), 57% had 1 gap, 29% had 2 gaps, 10% had 3 gaps, and 4% had 4+ gaps. 

Results suggested that male gender (adjusted odds ratio [aOR] 1.79) and younger than 50 years in age (P <.05) were associated with having a gap among all patients. Additionally, white patients were more likely to have a gap in Medicaid than Hispanic patients (aOR 0.70). Individuals enrolled in HIVRN after 2006, representing a shorter overall duration of HIV care, were less likely to have a gap compared with those who enrolled earlier (aOR 0.45).

 

Information about pregap and postgap viral suppression was available for approximately 25% of those who had Medicaid coverage gaps. Of those, 25.8% did not have viral suppression either pregap or postgap, while 53.7% had viral suppression both pregap and postgap, which may be the result of accessing other sources of antiretroviral therapy coverage. The strongest association with postgap viral suppression was pregap viral suppression (aOR 15.76). 

Overall, study authors concluded that “active engagement in case management and decreased burden for Medicaid enrollment can help ensure continuous Medicaid coverage for [people with HIV].”

Reference

Monroe A, Myint L, Rutstein R, et al. Factors associated with gaps in Medicaid enrollment among people with HIV and the effect of gaps on viral suppression [published online April 24, 2018]. J Acquir Immune Defic Syndr. doi: 10.1097/QAI.0000000000001702

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