Medicaid Expansion, HIV Testing, and HIV-Related Risk Behaviors in the United States, 2010-2017

Objectives. To examine the relationship between Medicaid expansion under the 2010 Patient Protection and Affordable Care Act and both HIV testing and risk behavior among nonelderly adults in the United States. Methods. We pooled 2010 to 2017 data from the Behavioral Risk Factor Surveillance System and focused our main analysis on respondents aged between 25 and 64 years from families with incomes below 138% of the federal poverty level. We used the difference-in-difference method and sample-weighted multivariable models to control for individual, state-area-level, and trend factors. Results. Medicaid expansion was associated with a significant 3.22-percentage-point increase in HIV test rates (P < .01) for individuals below 138% of the federal poverty level, with the largest impacts on non-Hispanic Blacks, age groups 35 to 44 years and 55 to 64 years, and rural areas. Expansion was not related to changes in HIV-related risk behavior. Conclusions. Medicaid expansion promoted HIV testing without increasing HIV risk behavior, but there were large disparities across race/ethnicity, age, and geographic area types. Public Health Implications. Nonexpansion states, mostly in the South, might have missed an opportunity to increase HIV test rates, which could have serious future health and financial consequences.