This Month in State Policy

NCSD’s This Month in State Policy is a corresponding series intended to complement state-specific policies outlined regularly in This Week in Congress. NSCD will post This Month in State Policy through early June to provide peak coverage and analysis of state legislative sessions. For more information about this summary or other state policy trends, please contact NCSD’s Policy Team at policyteam@NCSDDC.org 

At-Home STD Test Kits: 

New York State Sen. Brad Hoylman-Sigal introduced a bill that mirrors California’s SB306 by requiring insurance coverage of at-home STD test kits; a similar bill was introduced last year in the same chamber but died in committee. With COVID-19 and mpox disrupting in-person services, demand for new rules around at-home testing kits could develop beyond California and New York. NCSD intends to monitor this potential trend to identify which policy components make it through tough legislative hurdles, including insurance regulatory concerns. In the end, if more state lawmakers successfully introduce and pass similar legislation, it could significantly impact the accessibility of at-home testing options.  

STD Insurance Coverage: 

State legislators in both Hawaii’s House and New Mexico’s Senate introduced bills that would require insurance carriers to cover STD screening and testing without cost-sharing. Expanded coverage could ignite conversations on Affordable Care Act regulations and whether essential health benefits (EHBs) can include STD coverage without state defrayal rules, which require states to cover new costs associated with additional coverage requirements. In response, states may hesitate to add new mandated insurance benefits if it increases state dollar expenditures. However, in New Mexico’s SB132, the state would not pick up extra costs since the law applies provisions to plans that already happen to cover STI testing (instead of introducing new coverage requirements for any plan). Whether this strategy to circumvent coverage mandates appeals to lawmakers remains unclear.  

PrEP and PEP at Pharmacies: 

Currently, eight states allow pharmacists to prescribe and dispense HIV prevention medications: California, Colorado, Oregon, Maine, New Jersey, Nevada, Utah, and Virginia; a few additional states may soon join them.  

HB1007 in Arkansas would authorize pharmacists to prescribe and dispense pre-exposure prophylaxis (PrEP) and non-occupational post-exposure prophylaxis (nPEP or simply PEP). If enacted, this would be the second state in the South to permit pharmacy access.  

In Massachusetts, H.B. 2238 would allow pharmacists to prescribe PrEP but require a primary care provider for subsequent fills. Similarly, a New York bill could allow pharmacists to prescribe PrEP, limiting the authority to 60 days before requiring a transfer to a licensed physician or nurse practitioner. Both states have historically supported infrastructure for PEP at pharmacies. For example, New York state law has allowed pharmacists to prescribe PEP since 2017.  

Finally, State Sen. Clarence Lam in Maryland proposed legislation that would enable pharmacists to prescribe PEP while prohibiting prior authorizations, step therapy, and cost-sharing for both PrEP and PEP. For years, HIV advocacy groups have demanded innovations to PEP access given its unique urgency (people must take PEP within 72 hours after exposure to HIV for it to be considered effective).  

Adolescent Policy: 

Several state lawmakers have filed legislation centered on “parental rights,” which often references “fundamental upbringing control” and empowers parents to opt children out of “sexuality-related” coursework or sexual health services.  

In fact, NCSD has identified at least one dozen bills introduced during state sessions in 2023 either defining or authorizing greater degrees of parental rights. So far, two have failed in Republican-controlled legislatures: HB509 in Mississippi would have allowed parents to opt their child out of any sex education program and died in committee. SB2188 in North Dakota would have required parental consent for minors’ health care services in addition to parental notification mechanisms; it failed 42-4 in the state senate.   

While some bills have failed, others have succeeded and could be further expanded. In 2021, for instance, Montana lawmakers adopted a new law that requires parents to be notified 48 hours before any instruction involving sexuality. While it has been challenging to implement, a Montana state representative introduced legislation this year to revise the law so violations of it are considered “gross neglect of duty.” 

Although parental rights are not a new phenomenon, the current political landscape in the U.S. may redefine its parameters and political utility, especially when measures are filed alongside attempts to ban health care for transgender youth. NSCD will continue to monitor this trend in adolescent policy to generate additional analyses, especially as lawmakers’ efforts in other states, such as Missouri, Kentucky, and South Carolina, gain momentum.  

Abortion: 

In the first full legislative year since Dobbs v. Jackson, a wide range of abortion-related bills have been introduced that directly respond to the landmark ruling, including its impact on out-of-state legal authority and medical provider liability.  

In New York, State Rep. Linda Rosenthal introduced a bill that would protect people who receive abortions lawfully in the state from out-of-state investigations or warrants; California Gov. Newsom signed a similar bill into law last year. This potential trend in states with protective abortion measures may play a role in determining how states can or cannot intervene in other jurisdictions’ legal proceedings, including when a person travels deliberately to a different state to receive abortion care.  

In addition to laws shielding patients from prosecution, there have been several bills targeting abortion providers, either as punitive or protective measures.  This trend has the potential to transform medical care if there are concerns from providers that any procedures ending in the termination of pregnancy (intentionally or not) could be subject to criminal investigation. 

Within states prohibiting or partially prohibiting abortions, new bills have been introduced to further define restrictions. HB2313 in Kansas, as one example, would provide legal protections for infants “born alive;” a similar measure was voted down by Montana voters in the 2022 midterms. Beyond this, dozens of bills further restricting abortion access have been introduced, further reinforcing the dominant role reproductive health policies will play in post-Dobbs state legislatures.