The Trump Administration’s newly announced initiative to end the AIDS epidemic in the U.S. by 2030 will require significant expansion of health care and supportive services, including outreach to at-risk populations and communities, services aimed at preventing new infections, and ongoing care and treatment for people living with an HIV diagnosis. Community health centers today serve an estimated 22 percent of people in the U.S. living with HIV/AIDS and receiving care for their condition, and because health centers are now a significant source of care for people at risk for or living with HIV, the President’s initiative intends to rely on their services in both preventing and treating HIV infection. To meet the goal of ending the epidemic – as is true in all efforts to expand medically necessary care in underserved communities – health centers will need to both ramp up service capacity and have a sustainable means of covering the cost of accessible, affordable high-quality care going forward, according to a new report from the Geiger Gibson/RCHN Community Health Foundation Research Collaborative at the George Washington University Milken Institute School of Public Health.
The administration’s initiative calls for targeting high-burden states, counties, rural areas and cities, including 7 states with substantial rural HIV burden, 48 counties in 19 states, Washington, D.C. and San Juan, Puerto Rico. Sixteen of the states designated as high-burden, either broadly or as a result of the presence of high-burden counties, as well as the District of Columbia, have implemented the Affordable Care Act Medicaid expansion. However, there is no Medicaid expansion in another 10 states considered high-burden, or which include designated high-burden counties. While all community health centers will face some challenges in ramping up services, sustainable expansion will be especially difficult in the 10 high-burden states that have not adopted the Medicaid expansion. In these states – Alabama, Florida, Georgia, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas – thousands of low-income, at-risk people may not be covered by Medicaid, which increases the risk of inadequate care and places additional burdens on health centers to identify sources of sustainable financing to support expanded care. Both Medicaid expansion and extending the Health Center Fund will be essential to meet the immediate needs of their communities, and the broader goal of ending AIDS. The authors recommend a 10-year reauthorization of the Health Center Fund, with additional funding targeted to HIV/AIDS prevention and treatment efforts, as well as expanded Medicaid coverage in the 10 high-burden, non-expansion states.
The report, “Community Health Centers and the President’s HIV Initiative: Issues and Challenges Facing Health Centers in High Burden States and Communities” is now available on our website.
Read the full report here.