New law pushes home testing for sexually transmitted diseases
California became 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 which raged almost unchecked as public health departments focused on COVID-19.
The rule, which is part of a larger law against the STI epidemic, went into effect on January 1 for people with state-regulated private insurance plans and will come into effect a little later. for the 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 their own homes, this provision could enable better disease surveillance in rural and underserved areas of the state, reducing stigma. of patients when they seek care and give them more control over their health, say infectious disease experts.
“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, the state’s Medicaid program, Medi-Cal, did not have the billing codes ready to start paying for STI tests. ‘by January 1. Federal regulators have also not approved the tests for home use, which could make labs reluctant to process them. And state analysis predicts that most networked healthcare providers won’t start ordering home tests for at least a year until they adjust their billing and other practices.
Nonetheless, 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 the pandemic, sexually transmitted infections reached record levels in the United States and California for six consecutive years, according to 2019 data from the 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. Of the 445 cases of congenital syphilis in California in 2019, 37 were stillbirths.
COVID-19 only made the problem worse because health services were overwhelmed to respond to the emergency, and stay-at-home orders pushed 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 one survey – have diverted some of their workforce. work of STIs to test and monitor COVID-19. A report accompanying the most recent investigation found that some STIs were “totally uncontrolled” due to reduced clinic hours, misappropriation of resources, shortage of test kits and burnout. Staff.
Some home STI tests can detect a single disease, but other kits can collect and send samples to look 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, while some oral HIV tests give results at home within minutes.
Ivan Beas, a 25-year-old graduate student at UCLA, 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.
Beas wanted to continue testing every few months after the study ended, he said, but the kit he used costs $ 289, which is out of reach 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, he 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 the new California law, state-regulated plans must cover home STI testing when ordered by a health care provider.
Privately insured Californians can take advantage of coverage immediately. How much they’ll have to pay for the tests – if any – 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 state’s Department of Health Services, which administers Medi-Cal, is working with the American Medical Assn. . and the federal government to create billing codes. The reimbursement rates for these codes will then need to be approved by the federal government.
The state does not know 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 Alabama and District of Columbia Public Health Departments send free kits to residents who request them, but neither jurisdiction requires insurance coverage for them. The National Coalition of STD Directors sends free kits to people through health departments in Philadelphia, Iowa, Virginia, Indiana, Puerto Rico, and Navajo County, Arizona. The list of beneficiaries is expected to grow in January.
Iwantthekit.org, a Johns Hopkins University project, has been sending 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 had nearly tripled – and that it would spread to all states if she could bill for insurance in the way prescribed by law Californian.
Testing falls into a murky regulatory area. Although they have been approved by the Food and Drug Administration, none have been approved for use in the home. Patients are expected to collect their own samples within the walls of a healthcare facility, and some labs may not analyze samples taken at home.
Public health officials cited other potential challenges: Patients may 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 patients are expected to report their test results to public health authorities themselves, some people will not follow up.
Vlad Carrillo, 31, has recently experienced such compromises. Carrillo used to get tested at a clinic in San Francisco, where they could get advice and other services. But Carrillo lost his apartment during the pandemic and moved around seven a.m. to Bishop, the only incorporated town in 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), one of the three main operational programs of KFF (Kaiser Family Foundation).