STD Plan Is Rejected by U.S.
The federal government has rejected a California proposal to provide antibiotics to treat the sexual partners of Medi-Cal beneficiaries infected with chlamydia.
The move by the U.S. Centers for Medicare and Medicaid Services could impede the state’s effort to reverse recent increases in the sexually transmitted disease. State health officials especially want to reduce the rate of reinfection among women, who face worse health consequences than men from chlamydia.
Because Medi-Cal is jointly funded by the state and federal governments, the state proposal to treat sexual partners not enrolled in the program was subject to approval by the Centers for Medicare and Medicaid Services. In rejecting the request, a federal health official cited rules governing the health program for low-income people.
“We understand the public health value of doing something like this,” said Linda Minamoto, associate regional Medicaid administrator. “But our bottom line was that we could not define the treatment of the partner as a service to the eligible [person], which is what we would have to do in order to pay for it.”
Minamoto said officials also were concerned about a state law that allows antibiotics for chlamydia to be dispensed without a doctor’s exam. “I don’t know that we, as an agency, wanted to encourage something like that. Typically, we wouldn’t consider that to be good medicine.”
The state’s request was the first of its kind in the nation.
“Of course we’re disappointed,” said Ken August, a spokesman for the state Department of Health Services.
Reaching out to the sexual partners of Medi-Cal enrollees makes medical and financial sense, public health officials said. If doctors treat only an infected woman--and not her sexual partners--she has a 15% to 30% chance of becoming reinfected with the disease within six months, research shows. And women who become repeatedly infected with chlamydia face possible infertility, scarring and ectopic pregnancies.
Treatment is relatively easy, usually consisting of a single dose of Azithromycin, a common antibiotic.
State officials said they don’t have legislative approval to pay for partner treatments with state-only funds. As a result, people with limited income will be forced to seek care at free clinics or through other subsidized programs.
“It certainly puts a roadblock into payment, but not for treatment,” said Gail Margolis, deputy director of medical care services at the state Department of Health Services. “There are other possible avenues.”
In 2000, the state Legislature approved the measure that allows doctors to prescribe medication to the partners of chlamydia patients, even if the physicians have never met the partners and do not know their identities. Normally, doctors must conduct a good-faith examination of patients before prescribing medications.
Public health experts had found that the partners of people infected with chlamydia often would not seek care on their own but would take drugs if they didn’t have to visit the doctor.
Preliminary data for 2001 suggest that reported infections topped 100,000 for the first time, up by nearly two-thirds in five years.
