Payment options for HIV testing would expand if ACA stands

With National HIV Testing Day approaching on June 27, the non-profit AIDS Institute advises that there are more opportunities than ever for HIV testing to be paid for by third-party payers. And if the Affordable Care Act (ACA) remains intact following constitutional review by the U.S. Supreme Court later this week, there will be even more testing opportunities in the near future.

"Paying for an HIV test should not be a barrier for someone to learn of their HIV status," commented Carl Schmid, deputy executive director of the AIDS Institute. "Private insurance companies, Medicaid and Medicare pay for HIV testing now for certain populations and in specific instances. With passage of health reform, coverage has already expanded and will greatly increase in the future."

Many private insurance plans have covered HIV testing for pregnant women and people who are identified as being at high risk for HIV, such as gay men and injection drug users. Health reform now requires all new plans to pay for HIV testing for these populations and all plans to pay in 2014. As an estimated 23 million people would gain access to health insurance through health exchanges in 2014 if ACA is upheld, and access to preventive services, such as HIV testing, would also expand. Passage of ACA also enabled the Secretary of Health and Human Services to require plans to cover annual HIV testing for all sexually active women beginning in August 2012.

All states currently cover "medically necessary" HIV testing under Medicaid, and approximately half of the states' Medicaid programs pay for routine HIV testing. Beginning in 2013, in order to incentivize coverage of preventive services, states will receive additional funding from the federal government for coverage of preventive services. In 2014, when an estimated 17 million people gain access to Medicaid, opportunities for paying for preventive services will also expand as they gain access to a payer of their healthcare. 
Medicare currently pays for HIV testing for pregnant women and those who are at risk for HIV, including those who ask for a test. With passage of the ACA, any patient cost-sharing associated with the cost of the test was eliminated.

In addition options to increase coverage of HIV testing may soon dramatically improve as the U.S. Preventive Services Task Force (USPSTF) is reevaluating its grade for routine HIV testing. Currently the USPSTF, which is key to coverage determinations, gives an "A" grade for HIV testing of pregnant women and "at-risk" populations, but only a "C" for routine testing. In August 2012, USPSTF is expected to release a draft recommendation for routine HIV testing.

"Obviously, the fate of ACA is now in the hands of the U.S Supreme Court, and its decision will determine if many of these coverage opportunities, some of which have already been implemented, will continue or not," added Schmid. "Some of them were in effect prior to ACA, and they will stand. It is also reassuring that some of the large insurance companies have indicated that they will continue to cover preventive services no matter how the Supreme Court decides. But it is clear ACA will be extremely beneficial to increased HIV testing," continued Schmid.

"The benefits of HIV testing are many and increased testing is essential to both the individual and public health," commented Michael Ruppal, executive director of the AIDS Institute. He continued, "Testing is the only way to learn of one's HIV status, which enables HIV-positive individuals to take advantage of the breakthrough medications now available. Once diagnosed, individuals are more likely to engage in behaviors that reduce the chance of transmission." 

Over half of new infections originate from someone who does not know they are HIV-positive. Additionally, there is now scientific evidence that treatment equates to prevention. If someone is tested and linked to care and treatment, and virally suppressed due to that treatment, that person's ability to transmit the virus is reduced by up to 96 percent. 

For these reasons, the Centers for Disease Control and Prevention has recommended that everyone know their HIV status. An estimated 18 percent — or 212,000 of the 1.2 million people with HIV in the U.S. — are currently unaware of their infection, according to the AIDS Institute.

Click here for more information about HIV testing.

Computer model image of AIDS virus attributed to Richard Feldman via National Institutes of Health.


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