Right now, poor, uninsured Texans with HIV/AIDS are served by two programs.
One of them is Medicaid. The other is the Ryan White Program. It's named after the teenager who fought prejudice against AIDS in the 1980s.
Both programs are federally funded.
In Texas, the Ryan White program functions as a last resort. More than twice as many patients are on Ryan White than on Medicaid, because Medicaid eligibility is so strict here.
That will change in 2014. That's when a provision in the Affordable Care Act will shift most of today's Ryan White patients to Medicaid. The sudden transfer of tens of thousands of people from one program to another worries HIV healthcare advocates like Januari Leo.
"I want this transition to be smooth. I want people to remain in care. I want service organizations to understand the gravity of this situation, and that they have to begin acting now."
Leo works at Legacy Community Health Services in Houston. It specializes in HIV care. Legacy accepts patients on Medicaid. But many other HIV clinics and doctors don’t. Leo says some clinics balk at the idea of accepting Medicaid clients because of the lower reimbursement rates.
"They're not going to be able to keep up with the cost of seeing patients, still. So patients are going to have to go elsewhere to get their services."
But going elsewhere for services isn't easy when you're dealing with the medical and social complexities of an HIV infection.
Morenike Giwa is the chair of the Houston Ryan White Planning Council.
She says patients may lose access to an HIV service provider in 2014, and they’ll face a daunting task.
"Now you have to take your Medicaid card, flip through the booklet that's been mailed to you, and look through the sea of names and try to determine 'okay, is this person going to be welcoming of me as an HIV person, if they're even accepting new clients to begin with?"
Januari Leo of Legacy says she and other advocates are urging patients and clinics to prepare now, years before the changes take effect. They’re also prodding state agencies like Health and Human Services to help ease the transition.
"We're getting that they are working on it — internally, steps are being taken. As with any government department, everything's kinda hush-hush, and it's very hard to get definite answers, but they are working on it."
It’s hard to get ready, though, when there’s still doubt about whether HIV patients will even get access to Medicaid in 2014. The very survival of the Affordable Care Act hinges on a case that goes before the U.S. Supreme Court this summer, and on the presidential election this fall.