California HIV/AIDS Research Program

While Medicaid expansion created healthcare access for millions in California, its impact on people living with HIV (PLWH) is more nuanced. Newly covered PLWH with behavioral health needs had to navigate separate mental health and substance use care systems, rather than receiving them in integrated care settings as they had under the Ryan HIV/AIDS White Program (RWHAP). We conducted 47 interviews to examine the impact of Medicaid expansion on PLWH with behavioral health needs in California. California’s historical division in its Medicaid funding streams created challenges in determining which payer should cover clients’ behavioral healthcare. Compounding these challenges was a perceived lack of cultural competence for serving PLWH, insufficient infrastructure to facilitate continuity of care, and unmet need for non-medical supportive services. The multi-payer model under health reform has compromised the administrative simplicity and integrated delivery of HIV and behavioral health services previously available to uninsured patients through the RWHAP.