Fewer students are getting tested for sexually transmitted infections at Cal State Long Beach’s Health Resource Center, according to data from the HRC, and school health officials are concerned.
Students with private health insurance or Medi-Cal must pay out of pocket for STI testing at the HRC or go to their off-campus provider, and the HRC is worried this may discourage students from getting tested.
The HRC charges students at-cost for STI testing unless they qualify for FamilyPACT, which is a program for low-income people that provides access to reproductive health care at no cost. Since the implementation of the Affordable Care Act, more students are covered by private health insurance or Medi-Cal, which disqualifies them from FamilyPACT, HRC coordinator Heidi Girling said.
“We actually saw quite a few students become insured for the first time in their life, which is awesome,” Girling said. “So now that they’ve gained insurance through Medi-Cal, they have their own private doctors off campus and they may not use us for that reason. So that is a concern because we’re convenient, and they want to use us.”
The number of students tested on campus for chlamydia in 2013 dropped by 1,007 students, or about 34 percent. The number of students tested for gonorrhea decreased by 32 percent and 44 percent for syphilis.
While the numbers for herpes culture tests stayed about the same and tests for human papillomavirus rose by 11 students, the decrease in the majority of testing is still concerning, Girling said.
When a student wants STI testing at the HRC but already has health insurance, the HRC has to refer them to their primary care provider unless the student wants to pay out of pocket for the lab tests. Although the charge for STI testing is as low-cost to students as possible, Girling says it still poses a hindrance. And having to go off-campus to a primary care provider or free clinic makes it more likely a student would put off getting tested.
“This is why students use us — because we’re convenient, we’re right here on campus and they can get appointments very quickly,” Girling said. “… We’re fast; you will never pay a copay.”
According to the Student Health Status Survey conducted in 2015 by the HRC, there has been a 2.6 percent decrease in students covered by FamilyPACT and a 15.3 percent increase in students covered by Medi-Cal since 2013. Visits to enroll in FamilyPACT at the HRC have also dropped by 20 percent since the 2012-13 school year.
Even though the HRC can bill FamilyPACT, they cannot bill Medi-Cal because the approval process to bill Medi-Cal is extensive and would require funding and staffing “beyond what the student health fee can do,” Girling said. To provide a comparison, Girling said to get approval to bill FamilyPACT took a two year application process and Medi-Cal is far more complex. She also said that the ability to bill Medi-Cal or other insurances requires an entire billing department, something that would drive the cost to students way up.
“The option of billing Medi-Cal [or] other kinds of private insurance have been discussed with both staff from the chancellor’s office and also administration from some of the other CSU campus health centers on a number of occasions,” Kristen Fabiszewski, assistant director and coordinator of quality assurance of the HRC, said. “Typically this kind of decision would be coming on a system-wide level and not by one of our individual health centers.”
Earlier this month the HRC shared its concern over the increases in the positivity rates of gonorrhea and syphilis on campus. The uptick for gonorrhea was 0.2 percent and 0.3 percent for syphilis, the data shows.
The raise is in line with the rest of the country, according to the Centers for Disease Control and Prevention’s 2014 Sexually Transmitted Disease Surveillance report. Girling said the rise, even a small one like this, is concerning because of gonorrhea’s resistance to antibiotics and the danger of syphilis if left untreated.
HIV and pregnancy testing is also provided at the HRC at no cost to students.
Getting tested for STIs regularly mostly comes down to cost and convenience, Nielan Barnes, medical sociology professor at CSULB, said. Regular testing is generally not a stigma anymore and is important to many students, she said.
“It’s really become demystified and de-stigmatized,” Barnes said. “I think that the real barrier for students is not stigma, but rather accessibility in terms of money and time. If they’re going into Student Health Services and being told, ‘You already have this benefit, but it’s part of a different health care component that you can’t access here, go to your private practitioner or other provider,’ that is increasing their cost, therefore decreasing their likelihood of getting tested at all.”
STI testing was fifth on the list of top ten reasons students were seen at the HRC in the last academic year. Tuberculosis testing, immunization clearances, “well woman” exams and sore throats were the reasons above STI testing.
Recently, the Associate Vice President for Student Affairs Dr. Mary Ann Takemoto proposed an increase in the Student Health Fee to be able to provide more services to students. Students currently pay $90 per year and Takemoto proposed an increase to $150 per year.
About 96 percent of the current budget for the HRC is taken up by salaries, leaving no room for outreach or additional programs and services for students, Fabiszewski said. The fee has not gone up since 2005 and is the lowest of all the CSUs.