The Kansas Department of Health and Environment used to provide free HIV testing kits and specimen analysis to 40 counties — but this year, it’s scaling back its services to cover just the 10 most populous counties, a move that health advocates warn could end up restricting care for some of the state’s most vulnerable residents living in rural areas.
State and federal agencies are attempting to allocate their prevention funds strategically. Since Kansas is considered a “low incidence” state for HIV, cutting back on free testing in some counties is an attempt to concentrate resources where they are most needed. But health officials warn that the strategy may backfire, particularly because the state’s poorest residents may not seek out preventative care and get themselves tested:
“What we’re really talking about is potentially decreased access to services,” said Michelle Ponce, executive director of the Kansas Association of Local Health Departments. “If there’s not an entity in a community able to provide HIV testing on a basis which clients can afford, it’s not going to be done.” [...]
In Kansas, Medicaid pays for HIV testing if a physician orders it, Wilmoth said.
Donna Sweet, University of Kansas director of internal medicine education at Via Christi Regional Medical Center in Wichita, cautioned that people who live in rural communities where everyone knows everyone may be unwilling to discuss their concerns with a primary care physician. They might not recognize the signs or understand the risks, she said.
“Certainly it’s going to make an impact. People who are poor generally don’t have the money to pay for anything that is not free,” said Sweet, who has been the principal investigator for the Mountain Plains AIDS Education and Training Center since 1988.
State officials note that, since Obamacare seeks to expand the Medicaid program to cover additional low-income people, the health reform law will help improve access to free testing in Kansas because Medicaid picks up the tab for HIV tests. But that’s only true if Kansas agrees to accept the optional expansion and add an estimated 240,000 low-income people to its Medicaid rolls. A Democratic lawmaker in the state recently introduced a bill to expand Medicaid, but Gov. Sam Brownback (R) — a staunch Obamacare opponent — hasn’t yet indicated whether he will cooperate with that provision of the health law.
Obamacare does take big strides to improve access to HIV testing and treatment. But, since the Centers for Disease Control estimates that about 20 percent of all HIV-positive Americans don’t realize they have the virus — which includes half of the HIV-positive people between the ages of 13 and 24 — a widespread emphasis on preventative testing is critical to reach that population.