TABLE 3—
Adjusted Association Between Medicaid Expansion Status and Insurance, Medicaid, or PrEP Use Among MSM: National HIV Behavioral Surveillance, 2017
| Model 1: Currently Insured (n = 8729) |
Model 2: Medicaid vs Other Insurancea (n = 7222) |
Model 3: Used PrEP, 12 mo (n = 4919)b |
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| CPRc (95% CI) | APR (95% CI) | CPRc (95% CI) | APR (95% CI) | CPRc (95% CI) | APR (95% CI) | |
| Expanded Medicaid (Ref = No) | 1.23 (1.18, 1.28) | 1.15 (1.06, 1.26) | 4.55 (3.40, 6.08) | 5.62 (3.75, 8.41) | 1.78 (1.52, 2.09) | 1.16 (1.01, 1.40) |
| Mo since expansion | 1.00 (1.00, 1.00) | 1.00 (1.00, 1.00) | 0.99 (0.98, 0.99) | 0.99 (0.99, 1.00) | 1.00 (1.00, 1.01) | 1.00 (1.00, 1.00) |
| Regiond (Ref = other): South | 1.03 (0.97, 1.09) | 1.01 (0.96, 1.07) | 1.06 (0.85, 1.31) | 0.96 (0.79,1.16) | 1.00 (0.78, 1.28) | 0.97 (0.80, 1.18) |
| Race/ethnicity (Ref = Non-Hispanic White) | ||||||
| Non-Hispanic Black | 0.96 (0.93, 1.00) | 0.99 (0.96, 1.03) | 2.69 (2.21, 3.27) | 1.53 (1.27, 1.84) | 0.68 (0.57, 0.82) | 0.81 (0.71, 0.93) |
| Hispanic/Latino | 0.89 (0.85, 0.93) | 0.92 (0.88, 0.96) | 1.80 (1.46, 2.22) | 1.33 (1.11, 1.59) | 0.75 (0.64, 0.88) | 0.94 (0.85, 1.05) |
| Other/Multiraciale | 0.96 (0.91, 1.00) | 0.98 (0.93, 1.03) | 1.36 (1.01, 1.82) | 1.10 (0.85, 1.42) | 0.81 (0.66, 1.00) | 0.95 (0.81, 1.11) |
| Age, y (Ref = 50–64) | ||||||
| 18–29 | 0.88 (0.84, 0.91) | 0.91 (0.87, 0.95) | 1.57 (1.25, 1.97) | 1.54 (1.22, 1.95) | 1.50 (1.16, 1.95) | 1.18 (0.96, 1.45) |
| 30–39 | 0.90 (0.86, 0.94) | 0.91 (0.87, 0.95) | 1.16 (0.90, 1.49) | 1.34 (1.05, 1.71) | 1.77 (1.34, 2.32) | 1.30 (1.06, 1.61) |
| 40–49 | 0.95 (0.91, 0.99) | 0.96 (0.91, 1.00) | 0.96 (0.72, 1.28) | 1.02 (0.77, 1.34) | 1.59 (1.19, 2.12) | 1.39 (1.11, 1.73) |
| Employment (Ref = Other/None): Full time | 1.09 (1.05, 1.14) | 1.06 (1.02, 1.11) | 0.41 (0.36, 0.48) | 0.62 (0.53, 0.72) | . . . | . . . |
| Povertyf | ||||||
| ≤ 138% FPL | 1 (Ref) | 1 (Ref) | 4.05 (3.52, 4.67) | 2.84 (2.42, 3.34) | . . . | . . . |
| > 138% FPL | 1.23 (1.18, 1.29) | 1.21 (1.15, 1.27) | 1 (Ref) | 1 (Ref) | . . . | . . . |
| Disability (Ref = No) | . . . | . . . | 1.85 (1.61, 2.13) | 1.34 (1.16, 1.55) | . . . | . . . |
| HIV status (Ref = HIV negative): positive | 1.07 (1.03, 1.10) | 1.08 (1.04, 1.11) | 2.00 (1.74, 2.30) | 1.51 (1.30, 1.76) | . . . | . . . |
| Insurance (Ref = None) | ||||||
| Medicaid only | . . . | . . . | . . . | . . . | 1.87 (1.45, 2.43) | 1.27 (1.05, 1.53) |
| Any other insurance | . . . | . . . | 2.08 (1.68, 2.59) | 1.22 (1.04, 1.44) | ||
| Disclosed sexual identity to provider (Ref = No) | . . . | . . . | . . . | . . . | 3.58 (2.64, 4.86) | 1.12 (0.92, 1.36) |
| Discussed PrEP with provider, 12 mo (Ref = No) | . . . | . . . | . . . | . . . | 17.68 (12.93, 24.17) | 16.62 (12.03, 22.96) |
Note. APR = adjusted prevalence ratio; CI = confidence interval; CPR = crude prevalence ratio; FPL = federal poverty limit; MSM = men who have sex with men; PrEP = preexposure prophylaxis.
Model 2 outcome was limited to MSM with Medicaid vs MSM who reported any other type of health insurance, excluding uninsured MSM.
Model 3 was limited to HIV-negative MSM who were aware of PrEP.
All models accounted for state’s Medicaid expansion status and were weighted for unequal selection probabilities, multiplicity, and nonresponse.
Southern region of residence was defined by the US Census Bureau as living in AL, AR, DE, DC, FL, GA, KY, LA, MD, MS, NC, OK, SC, TN, TX, VA, or WV.
Other racial groups were American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, and multiracial.
Poverty defined by 2017 Department of Health and Human Services federal poverty guidelines: https://www.federalregister.gov/documents/2017/01/31/2017-02076/annual-update-of-the-hhs-poverty-guidelines.