Maryland's Initiatives to Assure Sustainable LHD STI Clinical Services for Vulnerable Populations

Background:  Gradual erosion of public health resources at the national, state and local levels, along with recent changes from the ACA, has lead the Maryland Department of Health and Mental Hygiene (DHMH) to take steps to  support sustainability of STI clinical services provided by the Local Health Departments, considered essential safety net providers for Maryland’s vulnerable populations.

Methods: Since before passage of the ACA, DHMH and other state health reform commissions began conducting systematic and ongoing assessments of macro-level structural factors affecting delivery of public health care services.   Factors include statutory, regulatory, administrative and programmatic policies that may impact LHDs’ capacity in the future. The DHMH Center for STI Prevention gathered and shared information on these processes to inform LHD decision making re future provision of STI public health clinical services. 

Results: Assessments indicated that in order for LHDs to maintain their capacity to provide critical safety net services, the state must: officially recognize LHDs as Safety Net Providers and Essential Community Providers; enable LHDs to generate and keep revenue, credential their clinicians, and establish contracts with third party payers; facilitate coordination between LHDs and other safety net providers via  formal or informal linkages to care for clients; support and assist LHD efforts to contract with other providers that cannot or do not want to provide STI and HIV screening, testing and treatment; support LHD alternative formats such as integration with  Family Planning, contracting out,  or closing services; support LHD efforts to retain a home base for DIS.  

Conclusions:  State-level recognition of numerous changes needed to support sustainability efforts for LHDs led to significant statutory, regulatory, administrative and programmatic initiatives currently underway in Maryland.  Ongoing assessment and support will be needed to address current and future barriers to care as the health care delivery system continues to evolve in Maryland.