The impact of managed care on access to highly active antiretroviral therapy and on outcomes among Medicaid beneficiaries with AIDS.

Medicaid has promoted managed care plans (MCPs) to control health care costs for HIV-infected enrollees. This article examines the impact of MCP enrollment on use of highly active antiretroviral therapy (HAART), antiretroviral therapy (ARV), hospitalization, and death among Medicaid beneficiaries with AIDS. A retrospective longitudinal cohort study of 7,028 Medicaid beneficiaries with AIDS in California was conducted from 1999 to 2001. The impact of MCP enrollment was estimated using single-equation and bivariate probit models. Baseline HAART use was found to be significantly lower for beneficiaries in MCPs versus fee-for-service (FFS). The effect was attenuated and not significant after correcting for selection bias. MCP enrollment was not associated with overall ARV use, mortality, or hospitalization. MCP enrollment does not substantially affect medication use or clinical outcomes. Before making changes to care delivery, policy makers should address the potential costs and benefits of MCP over FFS Medicaid for chronically ill beneficiaries.