HIV

Medicaid (traditional state Medicaid programs and Medicaid expansion programs) reimbursement of healthcare providers for costs associated with routine HIV screening, regardless of the patient’s HIV infection risk. (In states with Medicaid expansion, persons insured under the expansion are covered for routine HIV screening as required by law [8], while enrollees in traditional state Medicaid programs might or might not be covered for routine HIV screening.)

How These Ratings Were Determined
These ratings reflect the extent to which state Medicaid programs supported routine HIV screening, as assessed by the Kaiser Family Foundation (KFF) and the National Alliance of State and Territorial AIDS Directors (NASTAD) (2,9,10).

Coverage of Routine HIV Screening—Traditional Medicaid: To assess coverage of routine HIV screening in traditional Medicaid fee-for-service programs, KFF surveyed state Medicaid officials in 2010 and 2013 (2). NASTAD updated the results in 2015 for all states without such coverage, except for two states (Alabama and Mississippi) that did not respond to requests for information (9).

Coverage of Routine HIV Screening—Medicaid Expansion Plans: Routine HIV screening is recommended with an “A” grade by the US Preventive Services Task Force and is covered without cost sharing in the “essential health benefits” package that Medicaid expansion plans provide to enrollees (4,11). Accordingly, all states that have expanded Medicaid coverage under the Affordable Care Act cover routine HIV screening for their expansion populations. State Medicaid expansion status was determined on the basis of data collected and posted by KFF as of April 29, 2015 (10).

Consistency of the state’s HIV testing law with key parameters of consent and counseling outlined in CDC’s 2006 HIV testing recommendations (3).

How These Ratings Were Determined
These ratings reflect the extent to which state laws governing HIV testing met every consent and counseling parameter stated below.

CDC researches state laws, regulations, and policies that could influence risk behaviors or alter the environment in which HIV prevention services are accessed and delivered (12). To assess HIV testing laws, staff reviewed laws and regulations in the 50 states and the District of Columbia using WestlawNext^© (an online legal research system), literature reviews, and web searches. Relevant laws and regulations were coded using the following parameters:

Consent parameters:

• Opt-out (rather than opt-in) testing
• Inclusion of HIV testing consent as part of general medical consent forms (rather than HIV-specific consent forms)
• Permission to give consent orally

Counseling parameter:

• No requirement for HIV prevention counseling prior to testing

Existence of a state statute, regulation, or policy that requires reporting of all CD4 and HIV viral load test results (detectable and undetectable); reporting of ≥95% of CD4 and viral load results to the state or local health department; AND reporting by the health department of ≥95% of laboratory results to CDC by the end of each year.

How These Ratings Were Determined
These ratings reflect the extent to which state CD4 and viral load reporting requirements were in place, as determined by a policy assessment conducted by CDC (5,6), and whether complete CD4 and viral load data were reported to CDC (5,6,13).

CDC researches state laws, regulations, and policies that could influence risk behavior or alter the environment in which HIV prevention services are accessed and delivered (12). To assess CD4 and viral load reporting requirements, staff reviewed laws, regulations, and directives in the 50 states and the District of Columbia using WestlawNext^© (an online legal research system), literature reviews, and web searches. Relevant laws, regulations, and directives were coded using the following parameters:

• CD4 reporting: Required laboratories to report all values (not just those below a specified threshold)
• HIV viral load: Required laboratories to report all results (detectable and undetectable)

States were assessed as having complete reporting of laboratory results to CDC if, in addition to having state laws requiring the reporting of all levels of CD4 and viral load, the following criteria were met: 1) laboratories that perform HIV-related testing had reported a minimum of 95% of HIV-related test results to the state or local health department, and 2) by December 2014, the state had reported to CDC at least 95% of all CD4 and viral load test results received during January 2012–September 2014 (13).

Statewide percentage of viral suppression among persons with diagnosed HIV infection. A person’s viral load is considered suppressed when the results of a viral load test show either that HIV is undetectable or there are fewer than 200 copies/mL of virus in the blood.

How These Ratings Were Determined
These ratings reflect whether states had a viral suppression prevalence ≥80% among persons aged ≥13 years who had HIV infection diagnosed by the end of 2011 and were alive at the end of 2012 (13).

Ratings are reported only for those states that met the following criteria: 1) the state’s law or regulations required reporting of all CD4 and all viral load data to the state or local health department (6), 2) laboratories that perform HIV-related testing had reported a minimum of 95% of HIV-related test results to the state or local health department, and 3) by December 2014, the state had reported to CDC at least 95% of all CD4 and viral load test results received during January 2012–September 2014 (13). Geographic designations of viral suppression reflect where persons resided at HIV diagnosis.