California is first state to require health insurers to cover home testing for sexually transmitted infections

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SACRAMENTO, Calif .– California has become the first state to require health insurance plans to cover home testing for sexually transmitted infections such as HIV, chlamydia and syphilis – which could help quell the epidemic of STIs that raged almost unchecked as public health departments focused on COVID-19.

The rule – part of a broader law tackling the epidemic of sexually transmitted infections – took effect Jan. 1 for those on state-regulated private insurance plans and will later apply to the millions of low-income Californians enrolled in the Medicaid program of the state.

By making it easier and cheaper for Californians to self-administer tests in the privacy of their own homes, this provision could improve disease surveillance in rural and underserved areas of the state, reducing the stigma that Patients suffer when they seek care and give them more control over their health, experts say.

“This is the first law of its kind, and I would say it is state of the art,” said Stephanie Arnold Pang, senior director of policy and government relations for the National Coalition of STD Directors. “We want to remove all the barriers so that someone can take an STI test, and the direct cost is a huge factor. “

But being the first has its downsides. Because the concept of insurance coverage for home STI testing is so new, Medi-Cal – the state’s Medicaid program – was unable to establish until January 1 the billing codes it has. need to start paying for testing. Additionally, federal regulators have not approved the tests for home use, which could make labs reluctant to process them. And one condition analysis predicts that most networked care providers won’t start ordering home tests for at least a year, until they adjust their billing and other practices.

Still, the situation is urgent and requires action, said State Senator Richard Pan, D-Sacramento, a pediatrician who drafted the law.

“We have children born in California with syphilis,” Pan said. “You would think that was gone in the Victorian era.”

Even before COVID, the number of sexually transmitted infections had reached record levels in the United States and California for six consecutive years, according to 2019 data from the Federal Centers for Disease Control and Prevention.

The rates of congenital syphilis, which babies contract from their mothers, illustrate the severity of the STI epidemic: cases increased 279% from 2015 to 2019 nationally and 232% in California. From 445 cases of congenital syphilis cases in California in 2019, 37 were stillbirths.

And the pandemic has made matters worse, with health services overwhelmed to respond to the COVID emergency and stay-at-home orders keeping people away from clinics.

In surveys of public health programs across the country since May 2020, the National Coalition of STD Directors found that most respondents – up to 78% in investigation – have diverted part of their STI workforce to test and monitor COVID. A report accompanying the most recent survey found that some STIs were “totally uncontrolled” due to reduced clinic hours, misappropriation of resources, shortage of testing kits and drug exhaustion. staff.

Some home STI tests can detect a single disease. Other kits can collect and send samples to check for a variety of infections. Depending on the test, patients take a drop of blood with a lancet or dab their mouth, vagina, anus or penis.

Some tests require patients to send samples to a lab for analysis. Some oral HIV tests give results at home within minutes.

UCLA graduate student Ivan Beas, 25, was frequently tested in a two-year research study. When clinics closed during the pandemic, researchers sent her a home kit.

The kit – which tests for HIV, hepatitis C, herpes, syphilis, chlamydia, gonorrhea and trichomoniasis – was discreetly packaged and came with simple instructions. It took Beas about 10 minutes to prick his finger, swab his mouth, and send the samples to the lab.

Graduate student Ivan Beas can’t afford a full home STI test for $ 289, so he waits hours to get tested for free at a clinic. Beas will be able to get home kits once Medi-Cal starts covering them.
Caroline May

Beas said he wanted to continue testing every few months after the study ended, but the kit he used costs $ 289, which is too expensive for him.

The last time he went to a clinic in person, “I spent two hours even waiting to be seen by a doctor because of their occupation,” he said.

Until Medi-Cal starts covering home testing, Beas said he will have to find time to get tested for free at a Planned Parenthood clinic.

“If insurance were to cover it, I definitely would do it more,” he said.

Under california new law, State-regulated health plans must cover home STI testing when ordered by a health care provider.

Privately insured Californians can take advantage of coverage immediately. How much, if any, they’ll have to shell out for testing depends on the type of plan they have, whether their provider is networked, and whether they fall into a category the federal government has designated for free testing.

Medi-Cal patients hardly ever face personal expenses, but they will have to wait for coverage as the California Department of Health Services, which administers Medi-Cal, is working with the American Medical Association and the federal government to create billing. codes. The reimbursement rates for these codes will then need to be approved by the federal government.

It’s unclear how long this process will take, according to department spokesman Anthony Cava.

The rule does not apply to the millions of Californians whose employment-based health insurance plans are regulated by the federal government.

Other states and organizations have experimented with home STI testing. The public health services of Alabama and the District of Colombia send free kits to residents who request them, but no jurisdiction requires insurance coverage for them. The National Coalition of STD Directors sends free kits to people through health departments in Indiana, Iowa, Philadelphia, Virginia, Puerto Rico, and Navajo County, Arizona.

Charlotte Gaydos, co-founder of Johns Hopkins University's Iwantthekit.org project, has been sending free STI test kits to residents of Maryland since 2004 and to Alaskans since 2011.

Charlotte Gaydos, co-founder of the Johns Hopkins University project Iwantthekit.org, has been sending free STI test kits to residents of Maryland since 2004 and to Alaskans since 2011.
National Institutes of Health

A Johns Hopkins University project called Iwantthekit.org has sent free kits to residents of Maryland since 2004 and to residents of Alaska since 2011. The program is funded by grants and works with local health departments.

Charlotte Gaydos, co-founder of the project, said demands for testing kits during the pandemic nearly tripled. Gaydos said it would expand to all states if it could bill for insurance under California law.

Testing falls into a murky regulatory area. Although they have been approved by the Federal Food and Drug Administration, none have been cleared for home use. Patients are expected to collect their own samples from within the walls of a healthcare facility, and some labs may not analyze samples taken at home.

Public health officials cite other potential challenges. For example, patients might not have the same access to counseling, treatment, or referrals to other services such as food banks that they would receive at clinics. And while people are supposed to report their test results to public health authorities, some will not follow up.

It took a year for Vlad Carrillo to figure out how to get tested after moving to Bishop, California.  Sending a kit home by mail ensured confidentiality and helped Carrillo avoid the stigma of testing.

It took a year for Vlad Carrillo to figure out how to get tested after moving to Bishop, California. Sending a kit home by mail ensured confidentiality and helped Carrillo avoid the stigma of testing.
Provided

Vlad Carrillo, 31, used to get tested at a San Francisco clinic that also offered counseling and other services but, after losing an apartment during the pandemic, moved about seven hours to Bishop in the rural Inyo county.

“Being away from town, it took me a whole year to find a way to get tested,” Carrillo said.

Carrillo eventually received the kit in the mail, avoiding the stigma of going to Bishop’s clinic, which is “more focused on the simple things” like preventing pregnancy. Without the test, Carrillo would not have been able to obtain PrEP, a drug to prevent HIV.

“Going without it for so long was really tough for me,” Carrillo said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues.


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