HIV Testing and Care Among Publicly Insured Enrollees With Schizophrenia: Is There a Benefit to Dual Eligibility?

BACKGROUND: Patients with schizophrenia experience gaps in the human immunodeficiency virus (HIV) care continuum. We examined the impact of dual enrollment in Medicare upon HIV testing and retention among Medicaid-enrolled patients with schizophrenia. METHODS: Using Medicaid Analytic eXtract and Medicare files from 2008 to 2012, we examined adult participants with schizophrenia enrolled in Medicaid or dually enrolled in Medicare and Medicaid. Our outcomes were (a) HIV testing probability among participants without HIV and (b) retention in HIV care among people living with HIV (PLWH) (two HIV viral loads or CD4+ counts >90 days apart and within 1 year). RESULTS: The average annual HIV testing probability was 4.9% among dually enrolled and 7.4% among Medicaid-enrolled patients (p < 0.001). Compared to Medicaid-only, HIV testing for dually enrolled patients were highest among those with opioid use disorder or sexually transmitted infection (STI); and lowest among study sample aged 50-59 years, Asian or White race. Among PLWH, the average retention probability in care was 54.7% for dually enrolled and 44.7% for Medicaid-enrolled patients (p < 0.001). Compared to Medicaid-only, retention probability for dually enrolled patients were highest among those with an STI or dyslipidemia, and lowest among younger sample. CONCLUSIONS AND RELEVANCE: Dual Medicare enrollment for Medicaid-enrolled patients benefitted HIV retention efforts more than HIV testing efforts. Differences in public insurance coverage between HIV care retention and testing among patients with schizophrenia, emphasizes the need for ongoing evaluation of the HIV care continuum as payor coverage and policies continue to evolve.