Since the start of the year, the state health department has stopped analyzing HIV tests for the Barton County Health Department and most other public health departments, forcing them to use private labs if they want to continue the service.
As of Jan. 1, the Kansas Department of Health and Environment Lab no longer provides free lab work or rapid or oral test kits for the local health department, according to a letter sent from KDHE Secretary Robert Moser, MD.
The Barton County Health Department, which did 386 HIV tests in 2012, now has a contract with the St. Rose laboratory in Great Bend so that testing here can continue, Director Lily Akings said.
“We do have to pass that cost on to the client,” she said. The health department now charges $40 for an HIV test, or $70 for a battery of tests for sexually transmitted infections (STIs) including HIV, gonorrhea and chlamydia.
Dr. Moser’s letter went to the 30 affected health departments late in November, giving them only a few weeks to prepare for the change, the Kansas Health Institute News Service reports. Ten counties with the highest concentration of positive tests are still receiving free lab work.
The state cutback is reportedly in response to a shift in federal HIV prevention funding. The Centers for Disease Control now require a 0.1 percent positivity rate for HIV testing in health-care settings, and a 1 percent positivity rate for testing in non-heath-care settings (such as prisons). Health departments were encouraged to continue providing HIV testing to clients who request the test, especially those reporting high-risk behaviors. And the state will continue to offer educational resources for HIV prevention. But the tests must be paid for by the agency or by the client, through insurance, public assistance programs, or out-of-pocket.
By 2014 this is not supposed to be an issue, Akigns said, because all Americans will supposedly have insurance under the Affordable Care Act.
Akings said few of the people who received tests through the local health department tested positive for HIV. She added that the state has been gradually pulling back from providing free lab services. Previously, KDHE stopped analyzing chlamydia tests for clients over 25 years old.
“If people don’t have the money, don’t have other resources, don’t have the insurance, I’m afraid they’re not going to come in for testing, which will delay treatment for those who test positive,” she said. “Infection will spread.”
Public health departments also help curb the spread of STIs in the community by finding all of the sexual partners of a person who tests positive, so those partners can receive treatment if necessary, Akings said.
Kansas routinely ranks low nationally in its support for public health agencies, KHI News Service reports.
The CDC has reconfigured the federal testing program it administers to focus on areas where the incidence of HIV/AIDS is greatest, according to Ralph Wilmoth, director of the HIV/AIDS program at KDHE. The 10 county health departments that will continue to get the aid include Johnson, Sedgwick, Wyandotte, Shawnee, Crawford, Pratt, Riley, Saline, Thomas and Trego counties.
The state also will provide the testing services to various organizations other than health departments in about a dozen counties. For example, in Douglas County the services will be continued for the Douglas County Aids Project, a non-profit group. In Reno County, the services will continue for the state prison in Hutchinson.
Wilmoth said the CDC made the program changes in anticipation of the full-scale implementation of the Affordable Care Act, which begins Jan. 1, 2014. Millions of Americans are expected to become newly eligible for Medicaid then and HIV testing is among the health services covered by Medicaid.
Linked to Medicaid expansion
But when the U.S. Supreme Court ruled on the health reform law, it concluded that each state had the option to not expand its Medicaid eligibility and Gov. Sam Brownback nor the Kansas Legislature have yet determined whether Kansas will broaden access to its program, which is known as KanCare.
“CDC made a strategic decision to reallocate HIV prevention resources with more of an emphasis on disease burden,” Wilmoth said in an e-mail to KHI News Service. “This shift caused funds to be directed more to high incidence states; Kansas is considered a low incidence state.”
For the same reason, local health departments also face the loss of funding for testing of other sexually transmitted diseases.
State officials said the number of new cases of HIV/AIDS reported annually in Kansas has remained steady at about 200 for the past five years and that resuming the discontinued services would require new or reallocated state spending.
Additional reporting by The KHI News Service, an editorially independent program of the Kansas Health Institute committed to timely, objective and in-depth coverage of health issues and the policy making environment.