Coverage and Care Pathways for People with HIV: A New Baseline

Lindsey Dawson and Jennifer Kates
Published: Aug 29, 2017

Appendix Table 1: Coverage Pathways by Payer and State
Background			Medicaid			Marketplace			Ryan White
State	HIV Prevalence¹	US Federal HIV Funding per Person with HIV, FY2014²		Medicaid Expansion Status³	Aged, Blind, Disabled Pathway⁴		Total No. of Issuers in State⁵	Average No. of Issuers per County in State⁶		ADAP Eligibility % FPL (Full Pay Rx)^7,8	ADAP Eligibility % FPL (Insurance Program)^7,8	QHP Insurance Purchasing (Premiums and/or Cost-sharing)⁹	Part B Medical Services Eligibility % FPL^7,10
United States	952,604	$3,151		Y = 32 States	23 States > SSI Level		33 States ≥ 3+ Issuers	33 States ≥ 3+ Issuers per County		Avg. 386%	Avg. 401%	Y= 48 States	Avg. 375%
Alabama	12,439	$3,065		No	73%		1	1		250%	250%	Yes*	300%
Alaska	637	$6,315		Yes	59%		1	1		400%	400%	Yes	400%
Arizona	14,726	$2,436		Yes	100%		2	1		400%	400%	Yes	400%
Arkansas	5,174	$2,269		Yes	73%		3	3		400%	400%	Yes	400%
California	119,589	$3,242		Yes	100%		11	3		500%	500%	Yes	***
Colorado	11,199	$4,560		Yes	73%		7	2		500%	500%	Yes	400%
Connecticut	10,236	$3,246		Yes	52%		2	2		–	–	Yes	–
Delaware	3,213	$2,826		Yes	73%		2	2		500%	500%	Yes	500%
D.C.	15,200	$5,067		Yes	100%		2	2		500%	500%	Yes	500%
Florida	103,696	$3,080		No	88%		5	2		400%	400%	Yes	400%
Georgia	46,870	$2,717		No	73%		5	2		300%	300%	Yes	300%
Hawaii	2,741	$3,343		Yes	100%		2	2		400%	400%	Yes	300%
Idaho	1,031	$4,397		No	73%		5	5		200%	n/a	No	200%
Illinois	34,843	$3,490		Yes	100%		5	2		300%	500%	Yes	500%
Indiana	10,279	$2,258		Yes	100%		4	3		300%	300%	Yes	300%
Iowa	2,355	$2,546		Yes	73%		4	2		200%	400%	Yes	400%
Kansas	2,884	$1,953		No	73%		3	2		300%	300%	Yes	300%
Kentucky	6,511	$2,387		Yes	73%		3	2		–	–	Yes	–
Louisiana	18,950	$3,516		No	73%		3	2		400%	400%	Yes	300%
Maine	1,454	$2,049		No	100%		3	3		500%	500%	Yes	500%
Maryland	32,002	$2,919		Yes	73%		3	3		500%	500%	Yes	400%
Massachusetts	19,290	$3,028		Yes	100%		9	7		500%	500%	Yes	500%
Michigan	14,944	$2,798		Yes	100%		9	3		450%	450%	Yes	450%
Minnesota	7,549	$2,759		Yes	100%		4	2		400%	400%	Yes	300%
Mississippi	8,983	$2,782		No	73%		2	1		300%	300%	No	300%
Missouri	11,560	$3,221		No	85%		4	1		300%	300%	Yes	300%
Montana	548	$7,362		Yes	73%		3	3		430%	430%	Yes	430%
Nebraska	2,014	$2,484		No	100%		2	2		300%	300%	Yes	200%
Nevada	8,405	$2,266		Yes	73%		3	2		400%	400%	Yes	400%
New Hampshire	1,240	$4,744		Yes	74%		4	4		400%	400%	Yes	400%
New Jersey	35,682	$3,287		Yes	100%		2	2		500%	500%	Yes	500%
New Mexico	3,096	$2,508		Yes	73%		4	4		400%	400%	Yes	400%
New York	130,753	$3,391		Yes	82%		14	5		435%	435%	Yes	435%
North Carolina	28,897	$2,418		No	100%		2	1		300%	300%	Yes	300%
North Dakota	306	$5,226		Yes	73%		3	3		400%	400%	Yes	400%
Ohio	19,911	$2,297		Yes	73%		10	3		300%	300%	Yes	300%
Oklahoma	5,605	$2,208		No	100%		1	1		400%	400%	Yes	400%
Oregon	6,275	$2,656		Yes	73%		6	3		400%	400%	Yes	250%
Pennsylvania	33,593	$3,102		Yes	100%		5	2		500%	500%	Yes	500%
Rhode Island	2,264	$3,267		Yes	100%		2	2		–	–	Yes	–
South Carolina	15,942	$2,501		No	100%		1	1		550%	550%	Yes	550%
South Dakota	492	$3,667		No	73%		2	2		300%	300%	Yes	300%
Tennessee	16,163	$3,644		No	73%		3	1		400%	400%	Yes	400%
Texas	77,896	$2,781		No	73%		10	2		200%	200%	No	200%
Utah	2,618	$2,974		No	100%		3	2		–	–	Yes	–
Vermont	662	$6,331		Yes	73%		2	2		500%	500%	Yes	500%
Virginia	21,740	$2,873		No	80%		8	3		400%	400%	Yes	400%
Washington	12,030	$2,872		Yes	73%		6	3		400%	400%	Yes	400%
West Virginia	1,896	$2,143		Yes	73%		2	2		400%	400%	Yes	400%
Wisconsin	5,952	$2,746		No	83%		15	3		300%	300%	Yes	N/A
Wyoming	269	$8,742		No	73%		1	1		80% **	500%	Yes	80%**
NOTES: Outside Marketplace, * 80% of area median income (For additional detail see notes in sources linked to below.) *** Eligibility determined at the local level SOURCES: 1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; vol. 27 November 2016. Available at: https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-2015-vol-27.pdf 2. Kaiser Family Foundation. State Health Facts. Total Federal HIV/AIDS Grant Funding by Agency, 2015. Available at: http://www.kff.org/hivaids/state-indicator/total-federal-grant-funding 3. Kaiser Family Foundation. State Health Facts. Status of State Action on the Medicaid Expansion Decision. Available at: http://www.kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act/ 4. Kaiser Family Foundation. State Health Facts. Medicaid Eligibility through the Aged, Blind, Disabled Pathway. Available at: http://www.kff.org/medicaid/state-indicator/medicaid-eligibility-through-the-aged-blind-disabled-pathway 5. Kaiser Family Foundation. State Health Facts. Number of Issuers Participating in the Individual Health Insurance Marketplaces. Available at: http://www.kff.org/other/state-indicator/number-of-issuers-participating-in-the-individual-health-insurance-marketplace 6. Semanskee, A. and Cox, C. Kaiser Family Foundation. Insurer Participation on ACA Marketplaces, 2014-2017. http://www.kff.org/health-reform/issue-brief/insurer-participation-on-aca-marketplaces-2014-2017/ 7. National ADAP Monitoring Project: 2017 Monitoring Report. 2017. Available at: https://www.nastad.org/sites/default/files/2017-national-adap-monitoring-project-annual-report_0.pdf 8. Cal. Health & Safety Code §120960(a)(b) Available at: https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=HSC&division=105.&title=&part=4.&chapter=6.&article 9. Personal correspondence with NASTAD and NASTAD. National ADAP Monitoring Project: 2017 Monitoring Report. 2017. Available at: https://www.nastad.org/sites/default/files/2017-national-adap-monitoring-project-annual-report_0.pdf 10. California Department of Health. Office of AIDS.

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