Increasing Access to Sexually Transmitted Infection Services in the Medicaid Program

The United States is undergoing an epidemic of sexually transmitted infections (STIs), including chlamydia, gonorrhea and syphilis. Although these bacterial infections are detectable and treatable, they often go undiagnosed.

The 2018 Centers for Disease Control and Prevention (CDC) STD surveillance report states that there were more than 1.7 million reported cases of chlamydia, and the rates of reported cases increased among all racial and ethnic groups from 2014 to 2018. Additionally, the reported cases of gonorrhea have increased by 82.6 percent since the historic low in 2009. According to CDC, the rates of chlamydia, gonorrhea and syphilis are all significantly higher among African Americans and Hispanic/Latinos than among whites, for both men and women. The rising rates of STIs are attributed to a mix of factors, including barriers to health services. 

The Medicaid program is in a unique position to reduce the transmission of STIs, particularly as STI rates rise, public funding is stagnant and funding for reproductive service shifts. Research has shown that there is an overlap between Medicaid eligibility criteria and the demographic markers of STI risk. Medicaid already plays a major role in STI care that could be expanded and strengthened to further address the epidemic. 

The CDC Foundation partnered with the George Washington University (GWU) School of Public Health and CDC on an assessment report to examine the barriers and opportunities for enhancing access to STI services through the Medicaid program. The research combined a national evidence review with focused case studies of four states varying by region and Medicaid expansion status, each of which include a jurisdiction with high STI prevalence: Georgia (Atlanta), Illinois (Chicago), Maryland (Baltimore) and South Carolina (Charleston). Key informant interviews were conducted with Medicaid officials, public health officials, providers and Medicaid managed care organizations.

The project identified a range of challenges and opportunities for states and Medicaid managed care organizations in leveraging the Medicaid program to improve access to STI services. In addition, the report provides recommendations for policy and programmatic actions. The report’s recommendations can be considered in light of the needs of local communities, particularly in the context of the current COVID-19 pandemic. 

Access the full report on the GWU website

This article was supported by Cooperative Agreement number 6 NU38OT000288-01-00 funded by the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the Department of Health and Human Services. The CDC Foundation’s support from CDC included full project funding of $450,000.

Nikka Sorrells
Nikka Sorrells, MPH, is a senior program officer for the CDC Foundation.