The expansion of California’s Medicaid program under the Affordable Care Act (Obamacare) made accessing comprehensive health care more challenging for low-income residents living with HIV. Prior to the expansion, this population received its care through the Ryan White CARE Act system, which provides comprehensive care in integrated settings.

Publishing their findings in Health Affairs, researchers conducted 47 interviews between April 2015 and June 2016 with 53 California public health officials, state and local policymakers and clinical or service providers to assess how the Medicaid expansion had impacted HIV-positive people in California who had behavioral health care needs.

The switch from an integrated-care model to a more piecemeal approach to addressing health care needs as seen under Medicaid coverage meant that low-income Californians with HIV had a less streamlined experience with the health care system. What’s more, such individuals found that the non–Ryan White health care providers demonstrated a lack of cultural competence, inadequate infrastructure to ensure HIV-positive patients experienced a continuity of care, as well as a lack of nonmedical wraparound services, such as transportation and child care.

“The multipayer model under health reform has compromised the administrative simplicity and integrated delivery of HIV and behavioral health services previously available to uninsured patients through the Ryan White HIV/AIDS Program,” the study authors concluded.

To read the study abstract, click here.


To read the American Journal of Managed Care article, click here.