SACRAMENTO, Calif. – California is just about the first state to want health insurance intends to cover at-home tests for sexually transmitted infections such as HIV, chlamydia and syphilis – that could help quell the STI epidemic that has raged nearly unchecked as public health departments have focused on covid-19.
The rule, a part of a broader law addressing the STI epidemic, took effect Jan. 1 for people with state-regulated private insurance coverage and can start working sometime later for that millions of low-income Californians enrolled in the state's Medicaid program.
By making it easier and cheaper for Californians to self-administer tests in the privacy of the homes, the supply could bring better disease monitoring to rural and underserved areas of their state, lessen the stigma patients experience when seeking care and provide them more control over their own health, say experts on infectious diseases.
“This is the first law of its kind, and I'd say it's type of cutting-edge,” said Stephanie Arnold Pang, senior director of policy and government relations for that National Coalition of STD Directors. “We want to reduce every single barrier for someone to obtain STI testing, and out-of-pocket price is a huge factor.”
But being first has its downsides. Since the idea of insurance coverage for home STI tests is so new, the state's Medicaid program, Medi-Cal, couldn't establish by Jan. 1 the billing codes it needs to start spending money on tests. Federal regulators also haven't approved the tests for home use, that could make labs reluctant to process them. Along with a state analysis predicts most in-network medical service providers won't start prescribing home tests for at least annually until they adjust their billing along with other practices.
Nevertheless, the situation is urgent and requires action, said state Sen. Richard Pan (D-Sacramento), a pediatrician who wrote the law.
“We have children born in California with syphilis,” Pan said. “You'd believe that went away in the Victorian era.”
Even before covid, sexually transmitted infections hit all-time highs within the U.S. and California for six years consecutively, based on 2022 data from the Cdc and Prevention. Rates of congenital syphilis, which babies contract using their mothers, illustrate the severity of the STI epidemic: Cases were up 279% from 2022 to 2022 nationally and 232% in California. From the 445 installments of congenital syphilis in California in 2022, 37 were stillbirths.
The pandemic only worsened the problem because health departments were overwhelmed answering the covid emergency, and stay-at-home orders kept people away from clinics.
In surveys of public health programs across the country since May 2022, the nation's Coalition of STD Directors discovered that most respondents Up to 78% in a single survey – have diverted a few of their STI workforces to test and monitor covid. A study that accompanied the most recent survey discovered that some STIs were “completely unchecked” because of reductions in clinic hours, diversion of resources, shortages of testing kits and staff burnout.
Some at-home STI tests screen for a single disease but other kits can collect and send samples to check for a variety of infections. Depending on the test, patients collect a small amount of blood with a lancet, or swab their mouth, vagina, anus or penis.
Some tests require patients to transmit samples to a lab for analysis, although some oral HIV tests give results in your own home in a few minutes.
Ivan Beas, a 25-year-old graduate student at UCLA, was getting tested frequently a part of a two-year research study. When clinics closed throughout the pandemic, researchers sent him a house kit.
The kit, which tests for HIV, hepatitis C, herpes, syphilis, chlamydia, gonorrhea and trichomoniasis, was packaged discreetly and came with easy instructions. It took Beas about 10 minutes to prick his finger, swab his mouth and send the samples to the lab.
Beas desired to continue screening himself every few months after the study ended, he said, however the kit he used retails for $289, which is out of reach for him.
The last time he visited a clinic personally, “I spent two hours waiting to even be seen by a doctor due to how busy they are,” he said. Until Medi-Cal begins covering home tests, he explained, he will have to find time to get tested free of charge in a Planned Parenthood clinic.
“If insurance were to pay for it, I'd definitely do it more,” he said.
Under California's new law, plans regulated by the state must cover home STI tests when ordered with a doctor.
Privately insured Californians can take advantage of the policy immediately. How much they will owe out-of-pocket for the tests – contrary – depends upon the type of plan they have, whether their provider is in-network, and when they fall into a category the us government has designated free of charge screening.
Medi-Cal patients almost never face out-of-pocket expenses, however they will need to wait for coverage since the Department of Healthcare Services, which administers Medi-Cal, is working with the Ama and the federal government to produce billing codes. The reimbursement rates for those codes will then need federal approval.
The state doesn't understand how long that process will take, based on department spokesperson Anthony Cava.
The rule doesn't apply to the millions of Californians whose job-based medical health insurance plans are regulated through the federal government.
Other states and organizations have attempted at-home STI tests. The public health departments in Alabama and the District of Columbia send free kits to residents who request them, but neither jurisdiction requires insurance coverage for them. The National Coalition of STD Directors is sending free kits to individuals through health departments in Philadelphia; Iowa; Virginia; Indiana; Puerto Rico; and Navajo County, Arizona. The list of recipients is anticipated to grow this month.
Iwantthekit.org, a task of Johns Hopkins University, continues to be sending free kits to Maryland residents since 2004, and to Alaskans since 2011. The program is funded by grants and works together with local health departments.
Charlotte Gaydos, co-founder of the project, said that requests for test kits throughout the pandemic nearly tripled – and that she would expand to every state if she could bill insurance the way the California law mandates.
The tests fall under a murky regulatory area. When they have been approved by the Food and Drug Administration, none happen to be cleared to be used at home. People are supposed to collect their own samples inside the walls of a health facility, and some labs may not analyze samples collected at home.
Public health officials cited other potential challenges: Patients may not have the same use of counseling, treatment or referrals to other services for example food banks they would receive at clinics. And although patients are designed to self-report the results of their tests to public health authorities, some people won't follow through.
Vlad Carrillo, 31, experienced such trade-offs recently. Carrillo used to get tested at a San Francisco clinic, where they could get counseling along with other services. But Carrillo lost their apartment during the pandemic and moved about seven hours away to Bishop, the only real incorporated city in rural Inyo County.
“Being from the city, it took me an entire year to find away out to get tested,” Carrillo said.
Carrillo eventually got the kit through the mail, avoiding the stigma of visiting the clinic in Bishop, which is “more focused on straight stuff,” like preventing pregnancy. With no test, Carrillo couldn't get PrEP, a medicine to avoid HIV.
“Going without it for thus long really was hard on me,” Carrillo said.
This story was produced by KHN, which publishes California Healthline, an editorially independent service from the California Healthcare Foundation.
Rachel Bluth:
rbluth@kff.org,
@RachelHBluth
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