Medicaid is a critical program for people living with and at risk for HIV. The program is the single largest coverage source for people with HIV, who are three times more likely to be covered by Medicaid than the general population. Forty percent of adults living with HIV in care are covered by Medicaid, compared to just 13 percent of the general population. The goal in caring for individuals living with HIV is to reduce the viral load so that the immune system keeps working to prevent illness as well as decreases the likelihood of individuals passing the virus to others. Understanding this viral suppression data is critical to improving the health outcomes of populations. It’s particularly important for Medicaid programs to have good viral suppression data given the significant role that Medicaid plays in coverage for people with HIV.

NASTAD (National Alliance of State and Territorial AIDS Directors), in partnership with AcademyHealth and the University of California San Francisco (UCSF) are working on a new project to build state capacity to improve this important data in Medicaid.

With funding from the Health Resources and Services Administration (HRSA), the project team will form a HIV quality data collaborative (HQDC) and work with 10 state HIV surveillance programs, Medicaid programs, and Ryan White HIV/AIDS Program (RWHAP) Part B recipients, to develop, implement, and evaluate strategies to improve the collection and reporting of HIV viral suppression data to the Centers for Medicare and Medicaid Services (CMS) as part of the annual Medicaid Adult Core Set, and will promote the dissemination and replication of effective strategies. Specifically, this project will work with Alabama, Arizona, Colorado, District of Columbia, Iowa, Maryland, Michigan, Tennessee, Virginia, and Washington.

While there have been some efforts over recent years to increase collaboration across HIV programs and Medicaid, barriers to meaningful partnership remain. For example, Mathematica’s analysis of the 45 states that reported at least one measure in the Core Set to CMS in the FY2018 reporting cycle, included six states that reported the HVL-AD measure and 39 states that did not report the measure in accordance with CMS’s technical specifications. Twenty-nine state Medicaid programs indicated that they did not report the measure because data was not available, primarily because the information is not collected (14 of the states), or because the data source was not easily accessible (8 of the states). Medicaid programs highlighted budget constraints and staff constraints as key factors, followed by data inconsistencies/accuracy, and not having the data linkages needed as the key challenges in obtaining the data needed to report the measure.

The project’s HQDC offers a unique opportunity for selected states to prioritize challenges, identify needed resources, and create a data infrastructure to facilitate reporting of the HVL-AD measure.

“By implementing a Breakthrough Series Collaborative, we will create a learning system that helps state teams build bridges between public health and Medicaid. This work will enable states to learn from each other and recognized experts as they knock down silos and lay an important foundation for improving the care and outcomes for so many individuals living with HIV” said Dr. Elizabeth Cope, Senior Director at AcademyHealth.

Reporting the HVL-AD measure to CMS is of strategic importance to improving health outcomes for people with HIV given the outsized role that Medicaid plays in HIV care and prevention. Increasing coordination across Medicaid, RWHAP, and HIV surveillance is critical to meeting the ambitious goals of ending the HIV epidemic.

Learn more about the project here


Jaime Adler, M.S., M.P.H.

Senior Manager, Public and Population Health - AcademyHealth

Jaime Adler is a Senior Manager of Public and Population Health at AcademyHealth where her work focuses on int... Read Bio

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