HIV and ACA Implementation on the United States-Mexico Border

Coauthor: Tom Donohoe, MBA Director and Principal Investigator, UCLA AETC, Pacific AETC U.S.-Mexico Border Project Coordinator

Case Study: Arizona Pedro is a 28 year old resident of Nogales Arizona who estimates he will make $12,065 or 105% FPL in 2014. He commutes to Tucson for HIV care at a Ryan White clinic. He has been in the U.S. legally for 7 years. He also receives HIV dental care and case management services through the Ryan White Program in Tucson. He wants to stay at his HIV clinic.


  • Under the ACA, will Pedro be required to purchase health insurance?
  • Will Pedro be able to continue to receive HIV dental care through the Ryan White Program?
  • If Pedro lived in Texas, how would his situation be different?

What do you think? Write us!

You may have read on previous Border HIV Training Blog entries that the U.S.-Mexico border region has some of the poorest health and economic outcomes in the United States. If the border region were a separate state, it would rank #1 in residents without health insurance.  The Affordable Care Act (ACA) will reduce these numbers greatly in the next year. Our U.S.-Mexico Border Federal Training Center Collaborative (FTCC) is providing training and technical assistance to help border HIV clinicians, clinics, and health departments with ACA implementation. 

Earlier this year we worked with key stakeholders to assess ACA implementation needs and develop representative case studies for each of the 4 Border States. On May 30, 2013, Tom Donohoe and I--along with Martha Guerrero from Texas/Oklahoma AIDS Education and Training Center (AETC) and Nicolé Mandel from the AETC National Resource Center--presented two HIV-focused border ACA Implementation webinars to more than 200 participants. These provider groups confirmed that the specific case study examples and interactive discussions used were key to helping clinicians understand the decisions, rights, and responsibilities of HIV patients and providers in the coming months.

We delivered this workshop in person at our FTCC two-day CME event in the San Diego border area on June 28-29, 2013, at the San Ysidro Health Center for more than 100 border providers. This event also featured Bernard M. Branson, MD, Associate Director for Laboratory Diagnostics with the CDC Division of HIV/AIDS Prevention. Dr. Branson talked about HIV screening in health care settings, how screening may change with ACA implementation and how that may or may not affect patients in Border States. Two best practices and goals for HIV screening in health care settings are:

  1. Screen all emergency department and inpatient admissions for HIV, preferably using fourth generation HIV tests
  2. Community clinics can bill payers for routine HIV screening with no cost sharing to patients

The U.S. Preventive Services Task Force recommends (Grade A) that clinicians screen for HIV infection in adolescents and adults ages 15 to 65 years.  The ACA law also makes critical investments in prevention, wellness and public health activities. Medicare and private insurance plans are now required to cover many recommended preventative services, including screening for HIV with absolutely no cost-sharing for patients.

We will provide a follow up to the May 30, 2013 webinar during Border Health Week on October 8, 2013.  Importantly, this second webinar will include updated and expanded details using case study discussions, and is timed to occur after the Marketplaces open to purchase private health insurance (or enroll in Medicaid) on October 1, 2013.  If you would like to participate, please email Joel Peisinger at [email protected].

Our border ACA efforts are also informing our FTCC partners’ ACA implementation efforts.  For example the Curry International TB Center will feature an ACA webinar, The Affordable Care Act and Tuberculosis Control: Navigating New Territorywith a case-based approach on August 23, 2013.

You can view the May 30th webinar Affordable Care Act (ACA) Implementation on the U.S./Mexico Border here (Please note that you will be prompted to complete a demographic form before viewing the recording. You will also receive a certificate of completion when finished).

Do you have HIV-related questions about ACA Implementation on the Border? Please ask us!

Your questions or comments can also help inform our October 8, 2013 Part II webinar.

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