Receipt of routine preventive care services among Medicaid enrollees with HIV: the role of physician reimbursement

Preventive care receipt is suboptimal for people with HIV. Low physician reimbursement may play a role. We examined physician reimbursement and receipt of five annual preventive care services for Medicaid enrollees with HIV. We used person-level administrative claims (Medicaid Analytic eXtract, 2008-2012), state Medicaid-to-Medicare physician fee ratios representing state-level Medicaid primary care reimbursement relative to Medicare reimbursement (Urban Institute, 2008, 2012), and county-level characteristics for 15 southern states plus DC. Generalized estimating equations assessed the relationship of a 10-percentage point increase in the fee ratio and annual receipt of lipid, glucose, syphilis, and cervical cancer (women only) screening and influenza vaccination. We examined subpopulations requiring greater care, enrollees aged <45 years, managed care enrollees, non-Hispanic Black enrollees, and non-Hispanic White enrollees. The sample included 55,237 adult Medicaid enrollees with HIV (179,002 enrollee-years). Services were received in <50% of total enrollment years except glucose screen (71.2%). A 10-percentage point increase in fee ratio was associated with an 11%-25% increase in the odds of receipt of each service. Findings were largely consistent across subpopulations and among non-Hispanic Black enrollees, but not among non-Hispanic White enrollees. Modest increases in physician reimbursement may improve receipt, and equity in receipt, of preventive care services.