AIDS Program, along with Medicare, are also currently the most common sources of care coverage for people with HIV. More than half of those living with diagnosed HIV infection in the United States are covered by these programs. Although not generalizable to all HIV-infected individuals in the United States, analysis of data from these specific programs, in addition to data from MMP, is essential to highlight how ACA provisions that affect program eligibility and coverage of services impact the care experiences of people with HIV. These data and analyses are especially important given the wide variation in eligibility and benefits across state Medicaid programs, as well as differences in implementation of the health insurance exchanges under the ACA.

Although they are often proprietary, private health insurer data should also be used to monitor the care experiences of people with HIV within the context of the ACA. Currently, almost one in five individuals with HIV has private health insurance. Many more individuals with HIV are likely to enroll in private health insurance with the implementation of new benefits and protections in the private health insurance market, such as the establishment of health insurance exchanges in states to help consumers purchase health insurance and the elimination of preexisting condition exclusions.

Recommendation 5. In addition to data from the Medical Monitoring Project, the Office of National AIDS Policy and the Department of Health and Human Services should use data from Medicaid, Medicare, the Ryan White HIV/AIDS Program, and private insurers to monitor the impact of the Patient Protection and Affordable Care Act on health care coverage and utilization at the state and program level.

Although health care reform will increase access to care coverage for people with HIV, it does not guarantee linkage to, retention in, and receipt of quality care. Individuals with HIV who transition across sources of health insurance coverage could experience disruptions in their continuity of care and the array of services that are available to them at any given time. For example, the Ryan White HIV/AIDS Program model of care provides a range of supportive services in addition to clinical care within a single “medical home.” Care for many people with HIV will likely shift from the Ryan White HIV/AIDS Program to other sources of care as the ACA expands other programs, particularly Medicaid, to cover adults who were previously uninsured. This change could affect the range of services available to individuals previously enrolled in the Ryan White HIV/AIDS Program and the quality of care that they receive. By bringing previously uninsured individuals into the health care system, the ACA will also place demands on the health care workforce to provide care to a greater number of individuals. Provider shortages and delays in service provision could

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