All states, except Alaska, are pursuing some type of managed care initiative. Enrollment of Medicaid recipients averages almost 50% across states, and ranges from less than 10% to 100%. The Balanced Budget Act of 1997 allows state Medicaid programs to: (1) convert to managed care without obtaining waivers; (2) require enrollment for most beneficiaries; and (3) permit MCOs easier entry into the Medicaid managed care market. Managed care contracts, like traditional insurance contracts, do not typically identify specific conditions. In 1996, 18 states referenced counseling and testing as a covered service, usually only in the context of family planning services, and one state (Florida), assured access to the AIDS Clinical Trials Group protocol number 076 (ACTG 076) (Wehr et al., 1998).
AIDS service organizations (ASOs) can be loosely defined as nonprofit community-based organizations offering a range of services to the affected population. Because of the range of services offered and funding received by these organizations, not only is it difficult to define them, but there is no precise count of the number of organizations. Most ASOs are located in cities receiving funds from the Ryan White Title I Emergency Relief Grant Program for Eligible Metropolitan Areas—areas with a high incidence of HIV/AIDS—although there are also many in smaller cities and towns throughout the country.
Population served: This generally includes the affected population as a whole, although some organizations may focus their efforts on a particular segment of the population (homosexual men, minorities, women).
Services provided: These range from referral to counseling and testing, and education, to the full range of comprehensive clinical and support services offered by a handful of organizations in major metropolitan areas. Approximately 90 ASOs receive funding directly from the CDC to provide health education/risk reduction services defined as outreach, risk reduction counseling, prevention case management, and community-level intervention to change perceptions of risk.
The first home collection HIV test was approved in 1996 and was available from two manufacturers until June 1997. There is currently only one manufacturer, Home Access Health Corporation, that provides testing kits. The kits costs $40–$50 and allow users to remain anonymous; results are obtained by telephone