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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.

Data collected from the International Collaborative Study of Oral Health Outcomes USA (ICS-II) research locations were used to evaluate the relationship between having a usual source of dental care (USDC) and access to dental services. The robustness of the USDC effect after reducing simultaneity bias was tested in the population-based samples using sensitivity analysis. Logistic regression results provided evidence that USDC was the strongest and most consistent predictor of a dental visit in the past 12 months regardless of geographic location, dental care delivery system, or cultural diversity of the population. Even after removing cases that had a USDC for less than 1 or 2 years, the effect remained. From a policy perspective, USDC remains critical to understanding and explaining dental care utilization patterns. The findings suggest the need for designing interventions to increase the availability of a regular provider among vulnerable populations.

In September 2006, the Centers for Disease Control and Prevention (CDC) released the "Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-care Settings" to improve screening and diagnosis. The CDC now recommends that all patients in all health care settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, a state-by-state review (including Washington, DC) of all statutes pertaining to HIV testing was performed and the consistency of these laws with the new recommendations was systematically assessed. Criteria were developed for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and the implications for implementation of the CDC recommendations in these various legal contexts were examined. The statutory frameworks of 34 states and Washington, DC, were found to be either consistent with or neutral to the new CDC recommendations, which would enable full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC recommendations, which would preclude implementation of 1 or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from being inconsistent to consistent with the guidelines. State statutory laws are evolving toward greater compliance with the CDC recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if they are interested in implementing the CDC recommendations.

In September 2006, the Centers for Disease Control and Prevention released 'Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Healthcare Settings' to improve screening and diagnosis. The CDC now recommends that all patients in all healthcare settings be offered opt-out HIV screening without separate written consent and prevention counseling. State law on HIV testing is widely assumed to be a barrier to implementing the recommendations. To help policymakers and providers better understand their own legal context and to correct possible misunderstandings about statutory compatibility, we performed a state-by-state review (including District of Columbia) of all statutes pertaining to HIV testing and systematically assessed the consistency of these laws with the new recommendations. We developed criteria for classifying state statutory frameworks as consistent, neutral, or inconsistent with the new recommendations, and we examined the implications for implementation of the CDC Recommendations in these various legal contexts. We found that statutory frameworks of 35 states were either consistent with or neutral to the new CDC Recommendations, enabling full implementation. Statutory frameworks of 16 states were inconsistent with the new CDC Recommendations, precluding implementation of one or more of the novel provisions without legislative change. In the 2 years since release of the recommendations, 9 states have passed new legislation to move from inconsistent to consistent with the guidelines. Indeed, state statutory laws were evolving in only one direction: toward greater compliance with the CDC Recommendations. Policymakers, provider groups, consumer advocates, and other stakeholders should ensure that HIV screening practices comply with existing state law and work to amend inconsistent laws if interested in implementing the CDC Recommendations.

<p class="Default">Public Health Critical Race Praxis (PHCRP) contributes three functional elements to health equity studies: a race conscious orientation; an antiracism lexicon based on Critical Race Theory (CRT); and an integrat­ed, reflexive approach. Few big data studies employ all three functional elements. There­fore, this article describes the application of PHCRP to the <em>Human Immunodeficiency Virus Testing, Linkage and Retention in care (HIV TLR) </em>study (N=3,476,741), which con­nects multiple large datasets to electronic medical records to examine contextual de­terminants of racial/ethnic disparities in HIV care continuum outcomes in southern Cali­fornia. As HIV TLR demonstrates, PHCRP's innovative tools and strategies help big data research maintain fidelity to CRT. <em></em></p><p class="Default"><em>Ethn Dis. </em>2018; 28 (Suppl 1):261-266; doi:10.18865/ed.28.S1.261</p>

Health insurance policies that require prior authorization for specialty care may be detrimental to persons with HIV, according to evidence that having a regular physician with HIV expertise leads to improved patient outcomes. The objective of this study is to determine whether HIV patients who can self-refer to specialists are more likely to have physicians who mainly treat HIV. The authors analyze cross-sectional survey data from the HIV Costs and Services Utilization Study. At baseline, 67 percent of patients had insurance that permitted self-referral. In multivariate analyses, being able to self-refer was associated with an 8–12 percent increased likelihood of having a physician at a regular source of care that mainly treats patients with HIV. Patients who can self-refer are more likely to have HIV-experienced physicians than are patients who need prior authorization. Insurance policies allowing self-referral to specialists may result in HIV patients seeing physicians with clinical expertise relevant to HIV care.

Previous studies concerning disparities in Human Immunodeficiency Virus (HIV) services use among vulnerable groups did not control for specific clinical need for care such as symptom events. Using the Andersen Behavioral Model of Health Services Use, the authors determined whether minorities, women, and the less educated (vulnerable groups) were less likely to receive care for HIV symptoms. Persons enrolled in the HIV Cost and Services Utilization Study were asked whether they received care for their most bothersome symptom. Surprisingly, minorities and women were no more likely to go without care than other groups. Those with Medicaid, Medicare, private health maintenance organization (HMO) insurance, or no insurance were less likely to receive care for symptoms than those with private-non-HMO insurance. Vulnerable groups were no less likely to use services for HIV-related symptoms when need for care was considered. However, disparities may exist for symptom-specific care among HIV infected persons covered by public or HMO insurance.