Kansas: Local Health Departments Fret Cutbacks in HIV Testing

In late November, the Kansas Department of Health and Environment (KDHE) sent letters to many of the state's medium and small counties announcing that KDHE will stop analyzing HIV tests and providing rapid or oral tests to these counties' local health departments by January 1, 2013. In the past, 40 local health departments received the free services. Ralph Wilmoth, director of KDHE's HIV/AIDS program, says that number has been trimmed to 10. KDHE gave the counties five weeks to make alternate arrangements, and encouraged county agencies to continue to provide HIV testing. After January 1, the affected counties or their clients will pay the costs through public assistance programs, insurance, or their own money. The letter also included some cost-comparison information to help the local departments shop for lab work, testing materials, and other program necessities.

This creates a new burden for cash-strapped county health departments that now may be unable to continue HIV testing. Local department heads were dismayed at the short notice of termination of these free services, fearing it would be challenging or impossible for some smaller departments to pay for the tests on their own.

State officials explained that the service reduction decision was made because of cutbacks in a CDC-administered federal testing program. The program has been reconfigured to focus on areas where the incidence of HIV/AIDS is greatest. Wilmoth said the CDC instituted the program changes in anticipation of the January 1, 2014, implementation of the Affordable Care Act. Many Americans are expected to become newly eligible for Medicaid then, and Medicaid covers HIV testing. However, when the U.S. Supreme Court ruled on the health reform law, it concluded that each state had the option not to expand its Medicaid eligibility. Neither Kansas Governor Sam Brownback nor the Kansas legislature has yet determined whether Kansas will broaden access to its program, which is known as KanCare.

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