The Transition of People Living with HIV/AIDS from Ryan White-Funded Care to California’s Early Medicaid Expansion Program: Lessons Learned and Looking Ahead

Executive Summary

In 2010, the Federal Centers for Medicare & Medicaid Services (CMS) approved a California Medicaid waiver (pursuant to § 1115 of the Social Security Act) that authorized counties to receive federal Medicaid funds for health services they provide to certain low-income individuals. In July, 2011 California took the first steps toward statewide Medicaid expansion by implementing a partial expansion under this waiver. The waiver expanded coverage through new programs called Low Income Health Programs (LIHPs) to over 500,000 low-income Californians. Counties began to provide those services in 2011, through the LIHPs. The county LIHPs can set income eligibility for the program at up to 200 percent of the Federal Poverty Level (FPL). The counties also may cap the program and create waiting lists. In 2012, several thousand Californians with HIV/AIDS who had previously received services through the Ryan White HIV/AIDS Program began to receive services through LIHPs instead. As California moves towards full health reform implementation in 2014, the experience with early expansion reveals several important lessons regarding care for people living with HIV/AIDS.

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