HIV managed care in the Maryland health choice program

Medicaid is the major source of insurance for patients with human immunodeficiency virus (HIV) infection, covering nearly 55% of those with AIDS and 29% of those with HIV. The Johns Hopkins AIDS Service began collecting information about Medicaid payments and resource utilization in 1990 and eventually initiated a managed-care program to serve patients with HIV. The program was started based on the assumption that internal management of funds could lead to more efficient resource utilization. Maryland Medicaid established a risk-adjusted capitated rate for patients with AIDS based on historic rates from 1995. There was no risk-adjusted rate for HIV infection without AIDS. Mandatory managed care was implemented in July 1997. Analysis of the Hopkins program after 3 years showed that Medicaid reimbursement for AIDS patients was adequate, but expenses for HIV-positive patients who did not have AIDS were significantly greater than Medicaid reimbursement. Analysis of the program shows that managed care with a risk-adjusted capitated rate can provide adequate reimbursement for AIDS patients, but this approach does not necessarily improve or reduce costs.