Abstract
BackgroundMany veterans engaged in care with the Veterans Administration (VA) health system are also enrolled in Medicare and/or Medicaid and may receive care both inside and outside of the VA. Use of dual health systems has been associated with worse outcomes. Veterans with HIV may have different rates of Medicare and Medicaid enrollment and may be at greater risk of poor outcomes related to non-VA use. This study compares the frequency and factors associated with Medicare and/or Medicaid enrollment and non-VA use in an HIV-infected and uninfected population of veterans.MethodsWe used data from the VA and Center for Medicare & Medicaid Services from 2004 and 2005 to determine the frequency of Medicare and/or Medicaid enrollment among a cohort of HIV-infected and uninfected veterans engaged in VA care. We then restricted the cohort to veterans enrolled in fee-for-service (FFS) Medicare and/or Medicaid with at least one hospitalization and identified characteristics associated with non-VA hospital admissions.ResultsHIV-infected veterans had higher rates of Medicare and/or Medicaid enrollment than uninfected veterans (38% vs. 33%, p < 0.01), though the opposite was true when our sample was limited to veterans 65 years and older (53% vs. 70%, p < 0.0 1). Among veterans enrolled in the VA and FFS Medicare and/or Medicaid, veterans with HIV had greater illness severity and more frequent hospitalizations, but were less likely to be hospitalized outside the VA (48% vs. 54%, p < 0.01). HIV infection was associated with lower odds of outside hospitalization (OR = 0.76 [95% CI: 0.68, 0.85]).ConclusionsVeterans with HIV have higher rates of Medicare and/or Medicaid enrollment, but lower odds of non-VA hospitalization. The VA integrated model of HIV care may discourage outside use among HIV-infected veterans.
Highlights
Many veterans engaged in care with the Veterans Administration (VA) health system are enrolled in Medicare and/or Medicaid and may receive care both inside and outside of the VA
Overall, Human immunodeficiency virus (HIV)-infected veterans engaged in VA care were more likely than uninfected veterans to be enrolled in Medicare and/or Medicaid (38% vs. 33%, p < 0.01) (Table 1)
The majority of Center for Medicare & Medicaid Services (CMS) enrolled veterans were enrolled in Medicare, but HIV-infected veterans were more likely than uninfected veterans to be enrolled in Medicaid, either alone or in combination with Medicare
Summary
Many veterans engaged in care with the Veterans Administration (VA) health system are enrolled in Medicare and/or Medicaid and may receive care both inside and outside of the VA. This study compares the frequency and factors associated with Medicare and/or Medicaid enrollment and non-VA use in an HIV-infected and uninfected population of veterans. An expansion of Medicaid coverage under the Patient Protection and Affordable Care Act of 2010 (ACA) will likely increase the proportion of CMS enrolled veterans [1]. Less is known about CMS use among veterans under 65 years of age, who may qualify for Medicare through disability, or those enrolled in Medicaid. People living with HIV are more likely to qualify for Medicare through disability than age, and Medicare currently provides coverage for. Medicaid coverage for HIV varies on a state-to-state basis, but it currently covers about 50% of the people receiving HIV care in the U.S [11]. Little is known about CMS enrollment among HIV-infected veterans, and the frequency and drivers of CMS use among veterans with both VA and CMS coverage
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