IlustrationIn 2014, many HIV patients who receive medication through state-based drug assistance programs will be shifted to other forms of health coverage.

It's an uncertain time for most HIV patients in the United States. A full two-thirds of them rely on government-subsidized health insurance -- or else have none -- and the health care reform law is about to shake things up.

Starting in 2014, when the major provisions of the law kick in, many of the HIV-positive patients who currently receive medication through state-based AIDS Drug Assistance Programs will be shifted onto the Medicaid rolls; others will receive subsidized coverage through their state's health insurance exchange.

As most AIDS advocates see it, that means better access to comprehensive health care for their patients, which most agree is an undeniable good thing. So why are so many AIDS program managers losing sleep over the full implementation of the health care reform law?

A new report in the journal Health Affairs shows widespread confusion among the program managers concerning the law and its implications for the services they provide.

"Many said that they were overwhelmed by the complexity of the Affordable Care Act, and some expressed fear that state AIDS Drug Assistance Programs would be eliminated entirely," the report states.

Primarily, many fear that if policymakers see the AIDS Drugs Assistance Programs as unnecessary or duplicative after 2014 -- and pull funding for the programs as a result -- patients could be left to navigate the complicated new health care landscape on their own. In states that decide not to expand Medicaid, a funding reduction for the AIDS Drug Assistance Programs could mean that some patients would lose access to affordable medications entirely.

Erika Martin, principal author of the study and assistant professor at Rockefeller College of Public Affairs & Policy at the University at Albany and fellow at the Rockefeller Institute of Government, interviewed AIDS Drug Assistance Program managers in 22 states to assess the way the health reform law will impact their services. She joined the PBS NewsHour to discuss her conclusions about how those program managers are -- or should be -- planning for such an uncertain future.

source: http://www.pbs.org