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

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 % FPL7,10
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.
Issue Brief

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