Association between enrollment in Medicaid expansion and healthcare utilization and outcomes in people with HIV in Nebraska, U.S.A.

Medicaid expansion in Nebraska allowed us to study the changes in healthcare utlization, adherence barriers and HIV outcomes following Medicaid enrollment. We conducted a prospective observational cohort study involving People with HIV aged 19 years or older who chose to enroll in Medicaid between October 1, 2020, and December 31, 2021. The participants completed a healthcare utilization questionnaire and an Adherence Barrier Questionnaire at baseline and 12-month post-Medicaid enrollment. Viral suppression was measured at baseline and the end of the study period. A total of 101 participants were enrolled in this study. At baseline, 5% were enrolled in Medicaid, 49% in ADAP, and 38% were uninsured. Improvements observed post-Medicaid enrollment included an increased ability to afford care (P < .001), seek care (P < .001), find providers (P = .025), attend routine checkups (P = .015), and an increase in median number of outpatient visits (P = .003). Difficulty paying for medications (P = .037), skipping ART doses due to cost (P = .001), and ART rationing (P = .001) improved. Medication authorization issues (P = .022) and co-payments (P = .016) appeared as barriers. Viral suppression significantly increased from 58.4% to 77.2% (P = .001). Medicaid enrollment following expansion in Nebraska was associated with improved healthcare access and utilization among PWH, while copayments seemed to be a barrier to adherence.