This Month In State Policy

Prenatal Syphilis Screening

Illinois Senator Karina Villa (D – Aurora) introduced SB119 which amends the state’s existing Prenatal Syphilis Act. The legislation broadens current language to state that any “appropriate health care professional” tests a pregnant person for syphilis at both the first prenatal visit and during the third trimester rather than an “attending physician.” Current law does not state when in the third trimester to test; SB119 clarifies it as 27-32 weeks of gestation.

Furthermore, the bill states that a health care professional “shall test” for syphilis rather than “take a sample of blood.” This more simplified language could encourage providers to utilize a greater variety of testing mechanisms, such as the point-of-care (POC) syphilis test recently approved for use by the FDA. POC tests have the capacity to increase treatment uptake by providing more immediate results, although confirmatory testing is still recommended

Advocates have applauded the bill’s efforts, including its syndemic impact. “Strengthening prenatal care through early detection of syphilis also enhances HIV prevention efforts, given the increased risk of transmission,” noted Aces Lira, Senior Manager in State Policy and Advocacy at AIDS Foundation Chicago.  “Ensuring timely and comprehensive screening is a critical step toward improving maternal and infant health outcomes and aligns with Illinois’ statewide plan to get us to zero transmissions of HIV by 2030,” he added. The bill unanimously passed the Senate Public Health Committee, 10-0.

Meanwhile, Nebraska policymakers advanced legislation NCSD analyzed last month that expands prenatal syphilis screening rules. LB41 will require providers to test pregnant patients at the third trimester and again at delivery. The bill passed the state’s unicameral chamber, 46-0, and moves to enrollment and review, a stage during which amendments are assessed for technical errors.

Medicaid and Pregnancy

In Arkansas, Gov. Sarah Huckabee Sanders (R) championed the Healthy Moms, Healthy Babies Act, which she signed into law on February 21. The act provides pregnant Arkansans with presumptive Medicaid coverage for 14 prenatal and postnatal visits. It also codifies reimbursement for pregnancy-related services, including doulas and community health workers. The expanded coverage could potentially increase access to congenital syphilis prevention, something for which timely treatment is paramount. According to the most recent surveillance data from the CDC, in 2023 Arkansas had the fourth-highest syphilis rate in the nation.

Alabama policymakers have also expanded Medicaid access during pregnancy with HB89. The bill would also provide presumptive Medicaid eligibility during pregnancy—up to 60 days. According to The Alabama Reflector, the state has struggled with high infant mortality rates and the bill garnered bipartisan support despite budgetary concerns. HB89 passed the state House 102-0 and is on its way to the Senate. Alabama is one of ten states in the U.S. that has not yet expanded Medicaid to cover adults up to 138% of the Federal Poverty Level, a beneficiary extension made possible by the Affordable Care Act.

In Idaho, the House chamber narrowly cleared HB138, a “reform-or-repeal” bill, that would mandate the state make policy changes to the Medicaid program or end its expanded eligibility parameters. Idaho voters approved Medicaid expansion by over 60% in 2018.

Gender-Affirming Care

Kansas legislators overrode a veto by Governor Laura Kelly (D) and passed SB63, otherwise known as the Help Not Harm Act. The bill prohibits the use of public funds for gender-affirming care, bans gender-affirming services for minors, and authorizes a civil cause of action against providers who perform such care unlawfully. Gov. Kelly vetoed a similar bill last year, which NCSD included in a This Month in State Policy post. In 2024, the vetoed legislation did not secure enough votes for an override after a roll-call vote resulted in two Republican legislators switching their votes. This year, the override succeeded 85-34 in the House and 31-9 in the Senate.