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James G. Kahn, MD, MPH, Brain Haile, Mpp, MA, Jennifer Kates, MPA, MA and Sophia Chang, MD, MPH

James G. Kahn is with the Institute for Health Policy Studies, Department of Epidemiology and Biostatistics; the AIDS Research Institute; and the Center for AIDS Prevention Studies, University of California, San Francisco. Brian Haile is with the Institute for Health Policy Studies, University of California, San Francisco. Jennifer Kates is with the Henry J. Kaiser Family Foundation, Menlo Park, Calif. Sophia Chang is with the Veterans Health Administration, Center for Quality Management in HIV Care, Institute for Health Policy Studies, University of California, San Francisco.

Correspondence: Requests for reprints should be sent to James G. Kahn, MD, MPH, Institute for Health Policy Studies, University of California, San Francisco, Box 0936, San Francisco, CA 94143 (e-mail: jgkahn{at}itsa.ucsf.edu).

Objectives. This study modeled the health and federal fiscal effects of expanding Medicaid for HIV-infected people to improve access to highly active antiretroviral therapy.

Methods. A disease state model of the US HIV epidemic, with and without Medicaid expansion, was used. Eligibility required a CD4 cell count less than 500/mm³ or viral load greater than 10 000, absent or inadequate medication insurance, and annual income less than $10 000. Two benefits were modeled, "full" and "limited" (medications, outpatient care). Federal spending for Medicaid, Medicare, AIDS Drug Assistance Program, Supplemental Security Income, and Social Security Disability Insurance were assessed.

Results. An estimated 38 000 individuals would enroll in a Medicaid HIV expansion. Over 5 years, expansion would prevent an estimated 13 000 AIDS diagnoses and 2600 deaths and add 5816 years of life. Net federal costs for all programs are $739 million (full benefits) and $480 million (limited benefits); for Medicaid alone, the costs are $1.43 and $1.17 billion, respectively. Results were sensitive to awareness of serostatus, highly active antiretroviral therapy cost, and participation rate. Strategies for federal cost neutrality include Medicaid HIV drug price reductions as low as 9% and private insurance buy-ins.

Conclusions. Expansion of the Medicaid eligibility to increase access to antiretroviral therapy would have substantial health benefits at affordable costs.

This article has been cited by other articles:

				J. Kates, R. Sorian, J. S. Crowley, and T. A. Summers Critical Policy Challenges in the Third Decade of the HIV/AIDS Epidemic Am J Public Health, July 1, 2002; 92(7): 1060 - 1063. [Abstract] [Full Text] [PDF]