STI Insurance Coverage

Hawaii policymakers are considering legislation that would expand insurance coverage for sexual and reproductive health care services, including STI screenings and counseling. SB2605 would require health insurance carriers to eliminate cost-sharing for abortion, STI screenings, HIV prevention medications, and contraceptive supplies, to name a few examples. The bill does not guarantee zero cost-sharing for STI treatment or diagnostic testing, and none of its provisions apply to high-deductible health care plans. While SB2605 passed the Hawaii Senate on March 5, it was recently amended by the House Health and Homelessness Committee to remove abortion and pre-exposure prophylaxis (PrEP) from the required covered services list. Whether the bill’s significant alterations will be acceptable to lawmakers in the Senate is unknown.

SB2605 received wide support from numerous organizations that provided testimony during the Senate’s committee hearings, including the Hawaii Medical Association, the American College of Obstetricians and Gynecologists, and Planned Parenthood.

Meanwhile, Mississippi lawmakers decided to not support new insurance protections for HIV prevention. SB2799, introduced by Sen. Angela Turner-Ford (D – Columbus) would have required health insurance plans to cover HIV prevention drugs, including counseling and three-site testing for chlamydia and gonorrhea. The bill died in the state’s insurance committee on March 5. According to the CDC’s 2020 HIV Surveillance Report, Mississippi has the fourth-highest rate of HIV diagnoses in the country.

At-home STI Testing

In 2021, California became the first (and only) state in the U.S. to pass a law (SB306) requiring health insurance carriers to cover at-home STI testing through self-collection; Illinois may become the second. SB3711, introduced by Sen. Lakesia Collins (D – Chicago), would require insurance carriers to cover “STI self-testing kits,” including the laboratory costs for processing specimens. The bill’s language mirror’s California’s groundbreaking law by defining “kits” as products that are recommended by either the Center for Disease Control and Prevention (CDC) or United States Preventive Services Task Force (USPSTF) and meet at least one of the following criteria: 1) has been waived under the 1988 Clinical Laboratory Improvement Amendments, 2) is FDA-cleared or approved; or 3) was developed by a laboratory in establishment with existing regulations and quality standards.

NCSD will continue to monitor SB3711 to assess its legislative success—something that has so far, not yet been replicated by another jurisdiction. Senator Brad Hoylman-Sigal (D – NY) introduced S1002 in 2023, which would have required similar coverage, but the bill never made it out of committee.

Adolescent Health

Lawmakers in two states are eyeing different approaches to minor consent for STI services. In Hawaii, Sen. Ron Kouchi (D – Kaua’i, Ni’ihau) introduced SB3125, which would allow adolescents aged 14 and older to consent to STI prevention services. Current Hawaii state law allows minors to consent to STI treatment, but not preventive services, such as PrEP or doxycycline for bacterial STI prevention, otherwise known as DoxyPEP. The bill has already passed two committees in the Senate and received testimony from a wide range of youth-centered organizations in support of the bill, including the O’Ahu Youth Action Board and Opportunity Youth Action Board Hawai’i. The bill passed both the Senate and Committee in the House, making its way to the full House for approval.

Meanwhile, policymakers in Alabama are considering new restrictions on minor consent to STI clinical services. Senator Ben Harris (R – Rogersville) introduced HB246, which would allow someone to consent to a range of services only when they reach the “age of medical majority,” which is 18 under state law. Services listed in the legislation include “venereal disease, alcohol toxicity, drug dependency, school counseling services, and detection or treatment of pregnancy.”

Harm Reduction and Syringe Service Programs

On March 4, Idaho’s House of Representatives passed HB617, which would repeal the state’s Syringe and Needle Exchange Act. The bill was introduced after the Boise Police Department raided two offices of the Idaho Harm Reduction Project, alleging that unauthorized drug paraphernalia was being circulated. To date, no arrests have been made or charges filed. The state’s current syringe law from 2019 notes that entities may “procure supplies needed to operate a syringe and needle exchange program,” but does not define “supplies” in the statute.

Despite evidence from the CDC stating that syringe access programs reduce HIV and hepatitis C incidences by 50%, some Idaho lawmakers used the search warrant as a springboard to denounce the program’s effectiveness. The bill’s sponsor, Rep. John Vander Woude (R-Nampa), stated that “I don’t believe [the program] has functioned by the guidelines that was originally set out,” as quoted in Big Country News.

According to an October report on Idaho Safer Syringe Programs, participants who visit an exchange site are five times more likely to get treatment and three times more likely to stop using drugs. Norma Jaeger from Recovery Idaho stressed that HB617 does not align with such evidence and instead relies on false assumptions about enabling substance use. “If you think offering sterile needles makes people want to use drugs, you don’t know why people use drugs,” she stated. “If you repeal this, people will die.”

In addition to HIV and hepatitis C prevention, syringe services programs have also been integral to overdose reversals by distributing naloxone to clients, an FDA-approved medication that rapidly reverses opioid overdoses. In Idaho alone, 1,351 lives were saved in 2022 with overdose reversal products supplied by exchange sites.

The bill passed the Senate’s Health and Welfare Committee and has been filed for a third reading.

LGBTQ+ Health Care

Arizona State Senator Janae Shamp (R – Surprise) introduced SB1511, which would require any insurance carrier who covers gender transition-related care to also cover “detransition care,” and mandate that carriers report the number of detransition cases they provided coverage for during a plan year, including the age of the insured recipient. Transition care refers to the numerous and varied clinical procedures an individual may undergo when they are transitioning to the gender with which they identify. “Detransition care” is when an individual reverses that decision and attempts to rescind the effects of any care received.

LGBTQ+ advocates have called the law “unnecessary and gratuitous” because it reinforces a narrative that LGBTQ+ people who receive gender transition-related care regret it—something that is rare according to available medical research. The bill has received significant opposition from local and national LGBTQ organizations, including the Arizona Center for Women’s Advancement, Stonewall Democrats of Arizona, and the Human Rights Campaign. So far, the proposed legislation has already passed the Senate along party lines and the state’s House Committee on Health and Human Services. A vote in the House is expected soon.