Medicaid and HIV/AIDS in the United States: A State-Level Analysis of Beneficiaries and Spending

People with HIV/AIDS rely disproportionately on the public sector for their health care, particularly Medicaid, estimated to be their single largest source of coverage in the United States. Despite the importance of Medicaid for people with HIV disease, however, few analyses have assessed the extent of its role for this population, either nationally or across the states. Prior studies have been quite limited, hampering the ability of policymakers and others to understand Medicaid's role for this population or to prepare for future changes, such as those expected as the result of the implementation of the Affordable Care Act in 2014. This dissertation helps to fill this gap by conducting the first-ever national analysis of Medicaid beneficiaries with HIV/AIDS, based on data from all states, for the 2003 to 2007 period. It not only provides a detailed description of Medicaid beneficiaries with HIV/AIDS, spending, and services, it documents significant variation by state across these areas. The analysis goes further to analyze the key correlates of variation, pooling data across states and using a state and time fixed effects model, in an effort to identify policy and programmatic levers that could be used to enhance Medicaid access and equity for people with HIV/AIDS. Overall, this study finds that there are two such levers—the federal matching percentage for the Medicaid program (FMAP) and physician supply, although the findings related to the FMAP suggest limits in its ability to promote equity across the states. In addition, those states that already opt to provide more generous Medicaid eligibility have greater Medicaid access for people with HIV/AIDS