New law calls for home testing for sexually transmitted diseases

California is 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 contain the STI epidemic, which rages almost unchecked as public health officials look to COVID- 19th

The rule, which is part of a broader law to fight the STI epidemic, went into effect Jan. 1 for people with government-regulated private insurance plans and will eventually apply to the millions of low-income Californians who sign up for the Medicaid program Have enrolled in the state.

By making it easier and cheaper for Californians to self-test in the privacy of their home, the determination could bring better disease surveillance in rural and underserved parts of the state, reduce the stigma of patients finding care, and give them more control Health, say infectious disease experts.

“This is the first of its kind, and I would say it is up to date,” said Stephanie Arnold Pang, senior director of policy and government relations for the National Coalition of STD Directors. “We want to break down every single barrier so someone can do STI testing, and cost of ownership is a big factor.”

But being the first also has its downsides. With the concept of home STI testing coverage so new, the Medicaid government’s Medi-Cal program didn’t have the billing codes ready to start paying for tests on Jan. 1. Federal regulators have also not approved the tests for home use, which could make labs reluctant to process them. And a state of the art analysis predicts that most in-network healthcare providers won’t start prescribing home tests for at least a year until they adjust their billing and other practices.

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

“We have California-born children with syphilis,” said Pan. “You’d think that went away in the Victorian era.”

Even before the pandemic, sexually transmitted infections hit all-time highs in the United States and California for six straight years, according to 2019 data from the Centers for Disease Control and Prevention. The rate of congenital syphilis babies born from their mothers illustrates the severity the STI epidemic: Cases rose 279% nationwide and 232% in California from 2015 to 2019. Of the 445 cases of congenital syphilis in California in 2019, 37 were stillborns.

COVID-19 only made the problem worse because health officials were overwhelmed with responding to the emergency and stay-at-home orders kept 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 redirected some of their STI staff to test and monitor for COVID-19 . A report accompanying the latest survey found that some STIs were “completely untested” due to reduced clinic times, redirection of resources, lack of test kits, and staff burnout.

Some home STI tests screen for a single disease, but other kits may 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 wipe their mouth, vagina, anus or penis.

Some tests require patients to send samples to a laboratory for analysis, while some oral HIV tests provide results at home in minutes.

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

(Caroline Mai / Special to The Times)

Ivan Beas, a 25-year-old graduate student at UCLA, was tested extensively as part of a two-year research study. When clinics closed during the pandemic, researchers sent him a home kit.

The kit, which tests for HIV, Hepatitis C, Herpes, Syphilis, Chlamydia, Gonorrhea, and Trichomoniasis, was packaged discreetly 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 plans to check himself further every few months after the study is complete, he said, but the kit he used was $ 289 which is out of his reach.

The last time he went to a clinic in person, “I spent two hours even being seen by a doctor because they are so busy,” he said. Before Medi-Cal begins treating home tests, he must find time to get tested for free at a planned parenting clinic.

“If the insurance covered that, I would definitely do it more,” he said.

Under new California law, state-regulated plans must cover home STI tests if ordered by a healthcare provider.

Privately insured Californians can take advantage of the insurance coverage immediately. How much they owe out of pocket for the tests – if any – depends on the nature of their plan, whether their provider is on the network, and whether they fall into a category that the federal government has set for free screening.

Medi-Cal patients almost never have out-of-pocket expenses, but they have to wait for coverage as the state Department of Health that manages Medi-Cal works with the American Medical Assn. and the federal government to create billing codes. The reimbursement rates for these codes must then be approved by the federal government.

The state doesn’t know how long this process will take, said ministry spokesman Anthony Cava.

The rule does not apply to the millions of Californians whose work-related health insurance is regulated by the federal government.

Other states and organizations have experimented with STI testing at home. Alabama and District of Columbia public health departments send free kits to residents who request them, but none of the jurisdictions require them to be insured. The National Coalition of STD Directors is sending free kits to people through health departments in Philadelphia, Iowa, Virginia, Indiana, Puerto Rico, and Navajo County, Arizona. The list of recipients is expected to grow in January.

Iwantthekit.org, a Johns Hopkins University project, has been shipping free kits to Maryland residents since 2004 and to Alaska residents since 2011. The program is funded by grants and works with local health authorities.

Charlotte Gaydos, co-founder of the project, said requests for test kits nearly tripled during the pandemic – and that if she could bill insurance the way California law requires, she would expand into every state.

The tests fall into a murky regulatory area. Although they have been approved by the Food and Drug Administration, none have been approved for home use. Patients are supposed to collect their own samples within the walls of a healthcare facility, and some laboratories may not analyze samples collected at home.

Public health officials cited other potential challenges: Patients may not have the same access to advice, treatment, or referrals to other services as food banks that they would get in clinics. And while patients are supposed to report the results of their tests to health officials themselves, some people won’t hold out.

Vlad Carrillo, 31, recently saw such compromises. Carrillo was previously tested at a San Francisco clinic for counseling and other services. But Carrillo lost her home during the pandemic and moved about seven hours to Bishop, the only registered town in rural Inyo County.

“Since I was out of town, it took me a year to figure out a way to get tested,” said Carrillo.

Carrillo eventually received the kit in the mail to avoid the stigma of going to the Bishop clinic, which “focuses more on direct things,” like birth control. Without the test, Carrillo couldn’t get PrEP, a drug used to prevent HIV.

“It was really hard for me to be without it for so long,” said Carrillo.

This story was produced by KHN (Kaiser Health News), one of the three major operating programs of the KFF (Kaiser Family Foundation).

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