Health Care Coverage and Preexposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men Living in 22 US Cities With vs Without Medicaid Expansion, 2017.

Abstract

<b>Objectives.</b> To compare health care coverage and utilization between men who have sex with men (MSM) in Medicaid expansion versus nonexpansion states.<b>Methods.</b> We used cross-sectional weighted data from the National HIV Behavioral Surveillance system, which used venue-based methods to interview and test MSM in 22 US cities from June through December, 2017 (n = 8857). We compared MSM in Medicaid expansion versus nonexpansion states by using the Rao-Scott χ² test stratified by HIV status. We used multivariable logistic regression to model the relationship between Medicaid expansion, coverage, and preexposure prophylaxis (PrEP) use.<b>Results.</b> MSM in expansion states were more likely to have insurance (87.9% vs 71.6%), have Medicaid (21.3% vs 3.8%), discuss PrEP with a provider (58.8% vs 44.3%), or use PrEP (31.1% vs 17.5%).<b>Conclusions.</b> Medicaid expansion is associated with higher coverage and care, including PrEP.<b>Public Health Implications.</b> States may consider expanding Medicaid to help end the HIV epidemic.