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Medicaid and HIV

In the United States, there are more than 1.1 million Americans living with HIV and Medicaid is a major source of health coverage for those of them who are eligible (PDF 136.26 KB). Before the Affordable Care Act, most individuals living with HIV were ineligible for Medicaid unless they had very low incomes, or were deemed permanently disabled due to an AIDS diagnosis. Starting in 2014, under the Affordable Care Act, states can receive federal Medicaid payments to provide coverage for the lowest income adults in their states, without regard to disability, parental status, or most other categorical limitations. States that implement the Medicaid expansion are likely to provide coverage to some people with HIV, providing care that can help them manage their condition and promote individual well-being. The Affordable Care Act also includes a variety of options for states to offer services to help (PDF 713.99 KB) those who need long-term services and supports at home and in the community. 

Wisconsin is one state that is using the Medicaid Health Home provision from the Affordable Care Act to address the needs of Medicaid beneficiaries living with HIV. Under that provision, health home services can be targeted to people with a chronic illness, including HIV/AIDS, who have been diagnosed or are at risk of being diagnosed with another chronic condition. In Wisconsin, specialized providers, such as the AIDS Resource Center of Wisconsin (ARCW), are delivering care that includes access to medical, dental, mental health and pharmacy services, as well as supports such as food, housing, legal and case management services. According to the Wisconsin Department of Health Services, “76 percent of ARCW patients on HIV medications have an undetectable viral load, which means many patients are managing their HIV as effectively as possible. Only about 25 percent of HIV patients in the U.S. are achieving this success.” Learn more  about the Wisconsin Medicaid Health Home Initiative for people with HIV/AIDS.

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