However, significant disparities remain in assuring access to the standard of care for HIV across geographic and demographic populations.

Conclusion 2: The current federal–state partnership for financing HIV care is unresponsive to the fact that HIV/AIDS is a national epidemic with consequences that spill across state borders. State Medicaid programs that provide a significant proportion of coverage for HIV care are dependent upon widely varying resources and priorities that produce an uneven and therefore ineffective approach to managing the epidemic.

Conclusion 3: Under the current patchwork of public programs that finance HIV care, many HIV-infected individuals have no access or limited access to the standard of care for HIV. Fragmentation of coverage, multiple funding sources with different eligibility requirements that cause many people to shift in and out of eligibility, and significant variations in the type of HIV services offered in each state prevent comprehensive and sustained access to quality HIV care.

Conclusion 4: The lack of sustained access to HAART, in particular, is an indicator of poor quality care. Without access to HAART, individuals face increased illness, disability, and death.

Conclusion 5: Low provider reimbursement in Medicaid and managed-care delivery systems has the potential to discourage experienced physicians from treating patients with HIV infection and to undermine the quality of HIV care.

Conclusion 6: The lack of nationwide data on the unduplicated number of individuals served and the services they received under the Ryan White CARE Act hinders accountability, quality monitoring, and outcomes evaluation, and impedes the improvement of the program.

Conclusion 7: The majority of HIV care is publicly financed, providing a strong incentive and opportunity for the federal government to finance and deliver care more effectively.

The Committee’s conclusions serve as the backdrop for considering a number of alternative options for the public financing and delivery of HIV care. These alternative options are discussed in Chapter 5.


Adams EK. 2001. Factors affecting physician provision of preventive care to Medicaid children. Health Care Financing Review 22(4):9–26.

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