The Effect of State Cost Containment Strategies on the Insurance Status and Use of Antiretroviral Therapy (HAART) for HIV Infected People

Arkadipta Ghosh, Pardee RAND Graduate School
Neeraj Sood, RAND Corporation
Arleen Leibowitz, University of California, Los Angeles

Abstract

In an effort to balance their budgets many states are considering reducing eligibility for Medicaid. Using variation in state policies, this paper models the effect of more stringent eligibility criteria for Medicaid on the insurance status and the use of antiretroviral therapy (HAART) for people living with HIV, a group heavily dependent on Medicaid. Using nationally representative data from the mid-1990's, we find that stricter eligibility thresholds for Medicaid raise uninsurance rates and reduce the use of antiretroviral therapy among HIV+ patients, especially for those who are disabled. These stricter eligibility thresholds in turn adversely affect the survival prospects of HIV+ patients by lowering the rate of HAART use. Our estimates suggest approximately 13,000 lives could have been saved if all states had adopted the eligibility thresholds of California. We do not find any evidence of a "crowding out" effect of public insurance on private coverage among these patients.