Expenditures for Persons Living with HIV Enrolled in Medicaid, 2006-2010.

Fleishman JA1, Monroe AK, Voss CC, Moore RD, Gebo KA.

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Abstract

BACKGROUND:

Costs of care for persons living with HIV (PLWH) have been high historically. Cost estimates based on data from one health care site may underestimate total expenditures; using insurance claims avoids this limitation. We used Medicaid claims data to comprehensively assess payments for care for PLWH between 2006 and 2010.

METHODS:

Five sites from the HIV Research Network (HIVRN) provided information on patients with Medicaid coverage. Medicaid data were obtained from the sites' states (MD, NY, and MA) and 3 surrounding states and matched to HIVRN medical record-based data. Individuals less than 18, those with Medicare, and those in Medicaid managed care plans were excluded. Medicaid and HIVRN data were compared to ascertain concordance in capturing any inpatient event and any antiretroviral medication (ART) use.

RESULTS:

Of 6,892 unique HIVRN identifiers, 6,196 (90%) were linked to Medicaid data. The analytic sample included 11,341 person-years ofMedicaid claims data from 3,697 individuals in fee for service (FFS) programs. The mean annual FFS payment for all services was $47,434; mean annual FFS payment for only medical services was $38,311. Concordance between Medicaid and HIVRN data was excellent for ART use, but HIVRN data did not record a substantial proportion of years in which Medicaid recorded inpatient use.

CONCLUSIONS:

Estimated Medicaid payment amounts in this study are higher than some prior estimates. More complete capture of expensive inpatient hospitalizations in Medicaid data may partially explain this finding. While inpatient care and ART medications contribute the most,expenditures for non-medical services are substantial.