CHARLESTON, W.Va. -- Shrinking federal funding and the Affordable Care Act are forcing West Virginia to reconsider how it pays for HIV testing, but local health departments will not be able to charge people or their insurers for those services.A bill that would have allowed health departments to begin charging for tests for HIV and other sexually transmitted diseases was overwhelmingly voted down by the House Health Committee on Monday. The Senate unanimously passed the bill 10 days ago.The Affordable Care Act's Medicaid expansion and insurance subsidies will mean more people will have health insurance that pays for programs like HIV testing. It also means less money for programs for people who remain uninsured.In the last two years, West Virginia has lost more than $600,000 of federal money for HIV-AIDS programs. Some of those cuts were planned, as the Centers for Disease Control and Prevention shift grant money to states with higher HIV rates. Other cuts are the result of decreased federal spending. And funding is expected to decline more as a result of the automatic budget cuts that took place March 1.None of the cuts is a result of the Affordable Care Act, but Dr. Marian Swinker, the commissioner of the West Virginia Bureau for Public Health, said that the law is already changing how the state health department does business."They have put us on notice that when people have more insurance they'll be sending less money," Swinker said. "We see that coming."Essentially the federal government will be spending more money to get people health insurance and less money on programs for the uninsured.
"The reason those grants were there was for the uninsured," said Health Committee Chairman Don Perdue. "As more people get insured we're not going to need them."Most insurance plans cover the cost of HIV and STD testing with no co-pay. For people without insurance, local health departments would charge on a sliding scale or waive the fee so that no one would be turned away.Swinker said that local health departments have already successfully instituted a similar program for immunizations and vaccinations.
Gov. Earl Ray Tomblin is one of only two Democratic governors who have yet to commit to expanding Medicaid under provisions of the care act.Delegate Meshea Poore, D-Kanawha, said that it was premature to assume that more people would have insurance without first knowing whether the state would expand Medicaid."We're still determining how we're going to approach ACA, so for the local health departments to come today and say ACA is now happening and more people are being insured, so this seems to me very premature," Poore said.Amy Shuler Goodwin, a Tomblin spokeswoman, said there was no link to Medicaid expansion or the ACA because health departments would have continued to provide free or reduced-price testing to those without insurance. Goodwin said that had the bill passed they would have encouraged local health departments to bill for services provided to people who have insurance. She said there was no timetable for a decision on Medicaid expansion.Other delegates were concerned that people would not get tested after reading headlines saying that health departments would charge even though free testing would still be available.
"If I hear that my local health department may not give this test, I'm going to be prone not to go because I can't pay it," said Delegate Clif Moore, D-McDowell. Moore urged the Department of Health and Human Resources to dig within its finances to find money to fund the testing. Like most state agencies, DHHR will have its budget cut by 7.5 percent in the next fiscal year. The House also just passed a bill that would allow the salary of the next DHHR secretary to rise by up to $80,000.Sen. Ron Stollings, a doctor and the bill's sponsor in the Senate, was disappointed."I don't think that DHHR can continue to pay for it because of the federal cutbacks," Stollings said. "I'm just afraid that they won't be able to do the tests and you might have a tough time finding a place. You'd have to go through hospitals or something like that instead of going to the local health department."When the bill was before the Senate, Loretta Haddy, the director of epidemiology at DHHR, said that the bill was crucial to allow local health departments to continue operations."The only way we can deliver basic public health services is to amend our legislation to allow local health departments to charge for delivery services," Haddy said.