Routine HIV Screening for Medicaid Beneficiaries

A survey of state Medicaid officials and their coverage of HIV screening found that about half of the states surveyed cover routine HIV screening through their Medicaid program while the other half cover only medically necessary testing. The survey was conducted by The Henry J. Kaiser Family Foundation as part of the 2010 update to their Medicaid Benefits Database.

HIV screening can be an important method to prevent the disease from spreading and can also help those who have the disease get the treatment they need. According to estimates from the Centers for Disease Control and Prevention (CDC), 1 in 5 of the approximately 1.2 million people living with HIV/AIDS in the United States is unaware they have the disease.

The CDC recommends that all healthcare settings conduct routine HIV screening for patients 13 to 64 years of age unless the patient opts out of the testing. The US Preventative Services Task Force recommends screening for pregnant women and those patients who may be at risk of HIV infection, but has not adopted the broader screening recommendations.

According to the Kaiser Foundation, one issue that often impacts routine screening rates is whether the testing is covered by private and public insurers.

It is estimated that Medicaid provides insurance coverage for almost half of all people with HIV who are receiving regular care; however, each state differs in its coverage policies for HIV screening. All states are required to cover medically necessary HIV testing, but routine screening is optional and each state has the ability to decide whether it will provide routine screening as a diagnostic or preventative benefit.

To learn more about individual state Medicaid policies, the foundation surveyed Medicaid officials in all 50 states and the District of Columbia to investigate coverage of HIV screening as of October 2010. They found that of the 47 states that responded to the survey, about half (23) reported covering routine HIV screening under their Medicaid programs. The remaining 24 states covered only medically necessary screening.

Coverage habits varied by region and the survey found that states in the western region of the country were most likely to cover routine screening. In that region, 9 of 12 states reported covering routine screening, while in the Midwest, 6 of 11 states covered routine screenings. States in the Northeast were less likely (4 of 8 states) to cover the routine screening, and those states in the South were the least likely to cover it. According to the results, only 4 of 16 southern states reported routine HIV screening coverage.

According to the fact sheet issued by the foundation, the majority (60%) of those people who have been diagnosed with HIV and AIDS in the United States are living in states that only offer medically necessary HIV testing in their Medicaid programs. However, when researchers reviewed the data for Medicaid beneficiaries who have HIV or AIDS, they found that 48% lived in states that offered only medically necessary screenings compared with 46% who lived in states covering routine screening for Medicaid beneficiaries.

The report concluded by noting that it will continue to be important to assess state’s coverage decisions for HIV screening in the coming years, especially as the Medicaid eligibility requirements expand when the Affordable Care Act goes into effect.