Table 2.

Theme Categories from Analysis of Semistructured Interviews with People with HIV in Virginia Regarding Transition to Virginia Medicaid in 2019 Due to Medicaid Expansion with Representative Participant Quote Examples and Frequencies

Theme	Representative quote	n (%)
A. Perceptions of Medicaid pre-enrollment
General feelings: describes general feelings toward Medicaid pre-enrollment		27 (96)
Positive	INTERVIEWER: “So you just kind of had an idea that it, like, helped other people with their healthcare but didn't know a ton about it?” INTERVIEWEE: “Yeah, cause certain medications are, like, very expensive, you know.” (black female, 18–25)	19 (68)
Neutral	“I would say somewhere neutral. I don't think it would think it would be negative but then, you know, I thought about what I heard so to me I was a little neutral.” (black male, 36–45)	15 (54)
Negative	“[My friends and family] like Medicaid but the problem with Medicaid that it doesn't help a lot like if you work, especially when a person is sick and they have a lot of health issues.” (black female, 36–45)	2 (7)
Perception that Medicaid improves your general health		25 (89)
Positive	“Financially I can't afford to pay for teeth on my own but Medicaid's helping me a lot with that and I appreciate that.” (black female, 36–45)	21 (75)
Neutral	“I thought about what I heard so to me I was a little neutral.” (black male, 36–45)	6 (21)
Perception that Medicaid improves your HIV care		15 (54)
Positive	“It's positive because I get the care I need.” (white female, 46–55)	10 (67)
Neutral	INTERVIEWER: “Okay, and did you think that it would have a positive or negative effect on your HIV care?” INTERVIEWEE: “No, I really didn't think about that part of it.” (Hispanic male, 26–35)	4 (27)
Negative	INTERVIEWER: “Did you think it would have a positive or negative effect on your HIV care?” INTERVIEWEE: “Negative… I don't think it would affect it because it's open for everybody, the coverage. You know, that's when I found out, you know, they was giving it to a lot of people.”	1 (7)
Lack of awareness/understanding	“I hadn't heard nothing about it” (black male, 56–65)	28 (100)
Access to care	“[T]hey pay for your medical expenses if you can't afford them and they pay for prescriptions and doctor visits, and transportation.” (black male, 36–45)	18 (64)
Better affordability/lower cost	“[Medicaid] helps, it helps pay medical bills that I can't afford because I don't have the means to have medical insurance otherwise.”	14 (50)
Prior experience with Medicaid or other insurance
Prior experience with Medicaid	“Oh I had Medicaid when I was very young.” (black female, 56–65)	9 (32)
Experience with other insurance (besides Medicaid)	“Oh, [private insurance] was pretty good, they pretty good. I mean, you know, they, everything's good.” (black male, 56–65)	8 (29)
Perception that marginalized individuals use Medicaid
Low income/stigma	“[Medicaid] is for people who can't afford their medical coverage and it's basically nothing.” (black female, 56–65)	9 (32)
Who is Medicaid for?: Perception of what groups use Medicaid	“[Medicaid is] a government program to help people with financial medical assistance.” (Hispanic male, 26–35)	6 (21)
B. Perception of switch to Medicaid
General feelings toward switching to Medicaid		23 (82)
Positive	“I was surprised cause I didn't know that I could be on Medicaid. I guess they changed that they broadened I guess the eligibility. That's what I was told, so excited.” (black male, 46–55)	18 (78)
Neutral	“To me it didn't really matter any one way cause I know it would just be another, you have to have to navigate smoothly no matter what, okay, and I just figured there would just be some bumps in the road with it and there are a few little hiccups where you have to call, make some calls and get it straightened out, and they'd straighten it out and that was that.” (white male, 46–55)	4 (17)
Negative	“I was okay with it. I was fine, yeah. It just made me a little worried about the providers.”	1 (4)
No problems with switch/indifference	“I haven't seen any difference or anything like that...I haven't had any real problems.” (white male, 56–64)	3 (11)
C. Sources of information
Formal sources	“I let my case manager...sign me up for Medicaid...it was through my caretakers down there [UVA] and my case manager.” (white male, 56–64)	28 (100)
Informal sources	“[I discovered eligibility] through a friend. They told me to go ahead and sign up.” (black male, 36–45)	15 (54)
Mail from Medicaid	“I think I've probably got like two or three advertisements from [Medicaid].” (Hispanic male, 46–55)	11 (39)
D. Enrollment process
Reason for choosing plan	“I think it was dependent on the co-pay.” (black male, 26–35)	24 (86)
Enrollment burden: describes participants' duration of enrollment, difficulty with administrative information/tasks, and experience with clarity of information
Duration of enrollment	“I don't think it was [complicated]...I don't think it was that long.” (white male, 56–64)	23 (82)
Difficulty with administrative information/tasks	“I always find it difficult to… try to find papers and gather stuff together.” (white male, 56–64)	7 (25)
Outside help needed/obtained?: describes interviewee's experience with self-efficacy in Medicaid enrollment decision making or having someone break down the enrollment process for them
Having someone break down process	“I let them make a lot of the decisions...any kind of paperwork I've always had a problem dealing with.” (white male, 56–64)	22 (79)
Self-efficacy in decision making	INTERVIEWER: “And how did you choose between these companies?” INTERVIEWEE: “Which one did the most.” (black female, 56–65)	15 (54)
Clarity of information: describes participants' experience with information clarity during their enrollment process		22 (79)
Positive	INTERVIEWER: “And did you find that the information was easy to understand through your social worker?” INTERVIEWEE: “Yes, she was pretty straightforward and very informative about Medicaid and that's how we can go about that.” (Hispanic male, 26–35)	20 (71)
Negative	“Honestly I have never fully understood any insurance, you know, whether it's Medicaid, Medicare, or private insurance, you know. It just goes over my head.” (white male, 56–64)	4 (14)
Insurance overlaps vs. gaps
Gaps in insurance coverage: describes difficulty with gaps in coverage or trouble with re-enrollment that contributed to a lack of access	INTERVIEWER: “Have any other aspects of your care changed with Medicaid? Is there anything else that's different?” INTERVIEWEE: “No. I mean, not that I'm aware of right now. I just been back on it recently cause I was away...I was in prison for a while.”	9 (32)
Overlap of Medicaid with other insurance/ADAP	“They didn't have me in the one system, they had me in the other system and I had to go to the Health Department to get my medicine for a month.” (Hispanic male, 46–55)	3 (11)
E. Changes after enrollment
General feelings: describes general feelings toward changes after participant enrollment		14 (50)
Positive	“Yeah I do have a generally positive opinion of Medicaid post-enrollment.” (white male, 56–64)	10 (36)
Neutral	INTERVIEWER: “Has your opinion about Medicaid changed since enrolling?” INTERVIEWEE: “I don't have none (black male, 36–45)	3 (11)
Negative	INTERVIEWER: “Has your experience with getting your medications changed other than what we discussed earlier?” INTERVIEWEE: “It's hard sometimes, it's hard for me, you know, but I have to get it.” (black male, 56–65)	3 (11)
Ryan White: describes effect on Ryan White post-enrollment
Use of Ryan White services	“Other than case management I don't really use [Ryan White services] yet. There's a process you have to go through to get to the Ryan White but you got the case management there and they help me work out with the bill I was getting.” (black female, 36–45)	27 (96)
No change to Ryan White services	“No, the services are pretty much the same.” (black male, 56–65)	16 (57)
Changes to Ryan White services	“Has [Ryan White support] changed at all since your Medicaid enrollment?” INTERVIEWEE: “No. Actually, it's better…I went to the dentist and whatever my dentist doesn't get paid for then the Ryan White picks up. I mean whatever my prescription, so that's a good thing and some of the doctors use Medicaid cards too to help with dental so yeah.” (black male, 36–45)	11 (39)
Provider: describes switching HIV provider, switching specialist provider without changing HIV provider, or not changing HIV providers post-enrollment
No major change in provider	“I'm still getting the service. I haven't seen any difference or anything like that.” (white male, 56–64)	22 (79)
Non-HIV specialist provider change	“I feel overwhelmed with appointments cause I have appointments and my kids have appointments and I forget about me sometimes and I miss appointments and the doctors just told me because I missed they're gonna have to let me go, but I'm still at the same company but just a different doctor.” (black female, 36–45)	4 (25)
Switching HIV provider	“I switched [HIV providers] because I moved at the same time.” (white male, 56–65)	3 (11)
Medication: describes changes or lack of changes to non-HIV and HIV medication and medication accessibility post-enrollment
No major change in HIV medication	“As far as right now I think everything's the same because I've been getting my prescription as scheduled so I'm taking everything the same as usual.” (black male, 56–65)	21 (75)
HIV medication access	“When I first started [Medicaid] I was getting it from the Health Center and then after a few months they started mailing it to me.” (black male, 26–35)	17 (61)
No major change in non-HIV medication	“Everything's still the same. I just turn in my card to my pharmacy, and they accept it and UVA at the doctor's office do too. I just present my card and they accept it, so everything's okay.” (black male, 46–55)	17 (61)
Non-HIV medication access	“I can't afford it and they don't pay for it...Medicaid won't pay [for Viagra].” (white male, 56–64)	7 (25)
Care/services: describes post-enrollment changes or lack of changes to care and access to services
No major change in care (in general)	“It's all pretty much the same. Good doctors, so I went from good doctors to good doctors and no bad experiences or anything.” (white male, 18–25)	19 (68)
Changes in access to services	“I've needed more care and I've gotten more care [since enrolling]. I've needed more services and I've gotten more services as I've needed.” (white female, 46–55)	17 (61)
Changes in health: describes no major change in, improvement in, or worsening of health post-enrollment
Improvement in health post-enrollment	“I think it's better and I think it's helped with me getting the things that I need with HIV and stuff like that, so yeah.” (black male, 46–55)	17 (61)
No major change in health	“Everything's kind of still the same.” (black male, 26–35)	8 (29)
Worsening of health post-enrollment	INTERVIEWER: “Did your health improve since you transitioned to Medicaid?” INTERVIEWEE: “Nope, it probably got worse.”	1 (4)
Changes to the cost of medications/services	“See it went up, you know. I mean, you know, I thought it was supposed to be decreased but it went up.…I'm thinking my co-pays, but I thought everything I get is supposed to be free and my medicine's supposed to be free so that's why I'm mad now cause I have to pay for some medicines and some I shouldn't have to pay for.” (black male, 56–65)	7 (25)
Dental care	“Mainly it's just dental insurance and I'd like to get my teeth care. I think that's very important.” (Hispanic male, 26–35)	5 (18)
F. Perceptions of Medicaid post-enrollment
General feelings: describes participant's general feelings toward Medicaid post-enrollment		26 (93)
Positive	Medicaid has been very good for me. I haven't had any issues with Medicaid at all.” (black female, 36–45)	26 (93)
Neutral	“Yeah, I mean I already have medicine, yeah. It's the same.” (black male, 26–35)	6 (21)
Negative	“If I had a choice I would not have Medicaid if that's what you want to know.”	1 (4)
Good care for HIV: describes participant's post-enrollment perception that Medicaid provides good care for HIV		28 (100)
Positive	“I think they do a pretty good job to make sure that we get our medicine and stuff like that and it's not a struggle to get there. I'm pretty sure the way they look at it here and I guess look at it is it's guaranteed for us to be able to have that medication, have that medication to be able to get it on time.” (black male, 46–55)	26 (93)
Neutral	INTERVIEWER: “… Do you think that Medicaid provides good care for people living with HIV?” INTERVIEWEE: “I don't know that either.” (black male, 36–45)	2 (7)
Negative	INTERVIEWER: “Do you think that Medicaid provides good care for people living with HIV?” INTERVIEWEE: “Oh, they could do better.” (black female, 56–65)	2 (7)
Uncertainty/lack of awareness post-enrollment	“I don't really know about much information about that.” (Hispanic male, 26–35)	2 (7)

For all quotes, participants' self-identified race, gender, and age group are stated, except for themes or race-gender categories with only one participant to preserve privacy.

ADAP, AIDS Drug Assistance Program; UVA, University of Virginia.