The study compares racial differences in access to highly active antiretroviral therapy (HAART) for human immunodeficiency virus (HIV) patients under Medicaid managed care and Medicaid fee-for-service (FFS). This study uses the HIV Cost and Services Utilization Study (HCSUS) data set. The analysis includes Black and White Medicaid enrollees with HIV/AIDS in 1996. Logistic regression is used to estimate the models with exposure to HAART as the dependent variable. This study suggests that Black enrollees still face barriers in access to care, even after Medicaid has assured financial access. Disparities in access to HIV/AIDS treatment exist under both Medicaid FFS and Medicaid managed care.