Vol 23, 2014 Annals of Health Law 35
THE ACA AND PEOPLE LIVING WITH HIV/AIDS
A. Public Health Plans
In passing PPACA, Congress sought to improve access to medical care
by expanding the nation’s public health care system. PPACA has a
substantial effect on two of the nation’s most vital public programs for
PLWHA in the United States, Medicaid and the Ryan White Program.
PPACA eliminates all non-income-based requirements for participation in
Medicaid, giving low income childless adults living with HIV/AIDS the
opportunity to enroll in the program for the first time. 47 The law has a more
indirect effect on the Ryan White Program, as the changes it has in store for
the nation’s system of HIV care will ultimately create an entirely new role
for the program. 48 These changes will have a substantial impact on
PLWHA, who disproportionately rely on public assistance for their medical
Medicaid is a public health insurance option administered jointly by the
States and the federal government. 50 Although Congress does not require
states to participate in the program, those that do must meet a number of
eligibility and coverage requirements if they want to receive federal
funding. 51 For example, Congress requires that states receiving federal
funding cover certain people, while giving them the option of covering
others. 52 Congress calls groups that states are required to cover “mandatory
eligibility groups,” and groups that states may or may not cover “optional
eligibility groups.” 53 If a state chooses not to cover an optional eligibility
group, it does not receive funding for that particular group only. 54 Despite
47. See infra Part III. A. 2.
48. See infra Part III. A. 2.
49. See Crowley & Kates, supra note 4, at 6.
50. Kaiser Family Found., Medicaid: An Overview of Spending on Mandatory vs.
Optional Populations and Services, 1 (2005) [hereinafter Medicaid: An Overview],
52. See id. at 2 (listing examples of mandatory versus optional eligibility groups).
Evolving significantly over its more than forty-year-long history, Medicaid has come to
include far more people than it did originally. Id. At its inception, the Medicaid program
was a type of welfare, available only to those who met those strict guidelines. Id. While
those eligible for cash assistance from programs like Welfare have, for the most part,
remained mandatory eligibility groups, many of the groups included in the Medicaid reforms
comprise optional eligibility groups. Id.