Background: State and local STD programs were severely impacted in 2008 by the recession and continue to feel its effects. In 2009, a survey by the National Coalition of STD Directors reported that 69% of states have cut STD program funds, and therefore services.
Methods: Case studies demonstrate programs adapting to changes in the STD funding landscape.
Results: STD programs are adapting to funding changes by promoting adherence to chlamydia/gonorrhea (CT/GC) screening criteria and by implementing third-party billing.
In 2009, the Arizona Department of Health Services (AZDHS) could no longer send CT/GC specimens to the state laboratory. AZDHS contracted with a private laboratory and incurred higher costs as a result. Given restricted funding, AZDHS reviewed screening criteria, strengthened targeted testing, and reserved public funds for testing those at highest risk. The percentage of CT test in women aged ≤25 increased from 76% (2008) to 95% (2010) while tests in women aged ≥26 decreased from 24% (2008) to 3% (2011).2
The Nevada Division of Public and Behavioral Health (DPBH) did not bill for STD services before 2012. As funds diminished, DPBH leadership advocated for third-party billing and developed the necessary systems and capacity. DPBH currently contracts with Medicaid and seven other third-party payers.
The Oregon State Public Health Laboratory (OSPHL) implemented Medicaid billing for CT/GC testing and captured $150,000 over two years. OSPHL is currently working to adapt its systems to support billing of Coordinated Care Organizations by collaborating with state programs and key staff members.
Conclusions: As sites adapt to diminishing funds, common barriers remain. Continued knowledge and resource sharing is needed at the national, state, and local levels in order to help sustain STD and other programs.