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HIV and Navigating the Affordable Care Act

When asked about the impact of the Affordable Care Act (ACA), an HIV activist in Key West, Florida said, "This is going to be a big learning curve for people currently receiving care under one system transitioning to another system." But here's the good news: The ACA was designed to expand health insurance coverage for millions of Americans1 and may help to alleviate healthcare disparities for people living with HIV. Under the ACA, health insurance coverage cannot be denied for preexisting medical conditions,2 including HIV. And that's good, because nearly 700,000 people in the United States don't get the care they need for their HIV.3

"We focus on serving the client and seeing
the big picture. It's a new era."

HIV Housing Expert, New York City

Watch Allied Health Care Providers share thoughts for helping people living with HIV adjust to changes from the Affordable Care Act.

A large-scale change like the ACA can be accompanied by uncertainty. You're doing your best to stay on top of things, and you know that asking the right questions can go a long way toward alleviating concerns. Make sure to ask your clients about some of the major changes associated with the ACA. For example:

  • The decision to purchase health insurance is no longer optional4
  • People without job-based health benefits or public coverage (Medicaid or Medicare) are required to purchase health insurance to avoid financial penalties4
  • They may be shifted into a more comprehensive Medicaid program5
  • Their access to the Ryan White Program may change5

The particular facets of the ACA can have a wide-reaching impact on the lives of people with HIV. You can formulate a successful action plan by ensuring your clients are aware of the changes and prepared to move forward.

"Florida happens to be one of the states that
is not expanding Medicaid, so we have some
challenges there..."

HIV Activist, Key West, Florida

To assist people in finding affordable health insurance, the ACA authorizes the states to create Health Insurance Exchanges (HIEs).5 The level of coverage a person receives will depend on variables like income level, current method of care, and the state in which they reside.5

It's important to note that some states have not established HIEs.6 If your state has not established an HIE, your clients can still purchase health insurance online at: www.healthcare.gov.

In addition, not all states have plans to expand Medicaid,5,7,8 even though Medicaid expansion is provided for in the ACA. If your clients live in states that are not expanding Medicaid they can still buy health insurance, and the cost of their premium will depend on their income level.8 Alternatively, they may need to access the Ryan White Program.

To find out if your state is expanding Medicaid, visit8:


"We are a full-service organization, but we don't get
Ryan White or CDC funding...we get by without it."

Executive Director, Non-Profit Organization, El Paso, Texas

It's likely some of your clients with HIV receive care through the Ryan White HIV Program (including the AIDS Drug Assistance Program, or ADAP, and the Ryan White Clinics). Under the ACA, some of these clients will likely make the transition to more comprehensive coverage provided by Medicaid (if Medicaid is expanding in their state).5 It is estimated that a majority of people now served by ADAP will transition to Medicaid.9 it's important to remember that the Ryan White Program is considered the payor of last resort10; providers must understand which clients should move from the Ryan White Program into either Medicaid or a HIE. To find a local Ryan White Program, visit:


"It's not rocket science; we've done this before."

Vice President-Policy, Non-Profit Organization, Chicago, Illinois

The most difficult time for any transitional period is usually the beginning. By working together and sharing ideas and strategies for success, health service providers can successfully navigate new changes impacting people living with HIV.

  1. 1. Affordable Care Act. www.medicaid.gov. http://www.medicaid.gov/affordablecareact/affordable-care-act.html.
    Accessed November 1, 2013.
  2. 2. What if I have a pre-existing health condition? www.healthcare.gov. https://www.healthcare.gov/what-if-i-have-a-pre-existing-health-condition. Accessed October 30, 2013.
  3. 3. CDC Fact Sheet - HIV in the United States: The Stages of Care. www.cdc.gov.
    http://www.cdc.gov/nchhstp/newsroom/docs/2012/Stages-of-CareFactSheet-508.pdf. Accessed November 2, 2012.
  4. 4. Affordable Care Act Tax Provisions for Individuals and Families. www.irs.gov. http://www.irs.gov/uac/Affordable-Care-Act-Tax-Provisions-for-Individuals-and-Families. Accessed November 2, 2013.
  5. 5. Key Provisions of the Affordable Care Act for the Ryan White HIV/AIDS Program. www.hrsa.gov. http://hab.hrsa.gov/affordablecareact/keyprovisions.pdf. Accessed November 2, 2013.
  6. 6. State Health Insurance Mandates And The ACA Essential Benefits Provisions. www.ncsl.org.http://www.ncsl.org/research/health/state-ins-mandates-and-aca-essential-benefits.aspx. Accessed November 2, 2013.
  7. 7. What if my state is not expanding Medicaid? www.healthcare.gov. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid.
  8. 8. Status of State Action on the Medicaid Expansion Decision, as of October 22, 2013.
    http://kff.org/health-reform/state-indicator/state-activity-around-expanding-medicaid-under-the-affordable-care-act. Accessed November 2, 2013.
  9. 9. Ryan White. www.aahivm.org. http://www.aahivm.org/ryanwhite. Accessed November 2, 2013.
  10. 10. Coordination between Medicaid and Ryan White HIV/AIDS Programs. www.hrsa.gov. http://hab.hrsa.gov/affordablecareact/medicaidinfobulletin.pdf. Accessed November 2, 2013.
  11. 11. Key Features of the Affordable Care Act By Year. www.HHS.gov. http://www.hhs.gov/healthcare/facts/timeline. Accessed October 30, 2013.
  12. 12. What key dates do I need to know? www.healthcare.gov. https://www.healthcare.gov/what-key-dates-do-i-need-to-know. Accessed October 31, 2013.
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