There are numerous aspects of the Patient Protection and Affordable Care Act that will be important for people in the United States with HIV infection, including consumer protections and private insurance reforms, establishment of health care marketplaces in every state, new benefit standards, Medicare fixes, prevention enhancements, expansion of Medicaid, and health system improvements. However, it is unlikely that these changes will address all the needs of people with HIV infection in the United States. The Ryan White HIV/AIDS Program will thus remain crucial for the provision of adequate health care to HIV-infected individuals, but it will need to change. Changes in the role of the Ryan White HIV/AIDS Program will depend largely on state decisions on Medicaid expansion and health care marketplaces. This article summarizes a presentation by Jennifer Kates, PhD, at the IAS-USA continuing education program held in New York, New York, in April 2013.