Abstract
Introduction
Rates of congenital syphilis cases are increasing, particularly among lower socioeconomic
populations within the southern United States. Medicaid covers a significant portion
of these births, which provides an opportunity to improve birth outcomes. This project
sought to collect information from key stakeholders to assess facilitators of and
barriers to Medicaid funding of prenatal syphilis screening and to provide insight
into improving screening and lowering incidence through the Medicaid program.
Methods
Seven southern states (Alabama, Georgia, Kentucky, Louisiana, North Carolina, South
Carolina, and Tennessee) were identified for this assessment. Researchers conducted
a legal and policy analysis for each state to gather information on factors affecting
congenital syphilis prevention, identifying knowledge gaps, and inform the development
of interview guides. Seventeen structured interviews with 29 participants were conducted
to gather information on facilitators and barriers to receiving timely prenatal syphilis
screening through the Medicaid program. Interview transcripts were analyzed and compared
to identify key themes.
Results
Barriers to timely prenatal syphilis screening include varied laws among the states
on the timing of screening, Medicaid reimbursement policies that may not adequately
incentivize testing, Medicaid enrollment issues that affect both enrollment and continuity
of care, and lack of clear understanding among providers on recommended testing.
Conclusion
This work provides insight into systemic issues that may be affecting rates of prenatal
syphilis screening and incidence among Medicaid enrollees and others in the U.S. South.
To address rising congenital syphilis cases, policymakers should consider requiring
third trimester syphilis screening, adopting policies to enhance access to prenatal
care, adapting Medicaid payment and incentive models, and promoting collaboration
between Medicaid and public health agencies.
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Biography
Naomi Seiler, JD, is an Associate Professor at the George Washington Milken Institute University School of Public Health. Her research focuses on the intersection of the healthcare system with a range of public health priorities, including HIV and STIs.
Biography
William S. Pearson, PhD, is a Health Scientist in the Division of STD Prevention at the CDC. His work focuses on the delivery of health services, specifically on the cost of, quality of, and access to sexually transmitted disease care.
Biography
Laura H. Bachmann, MD, MPH, is the Chief Medical Officer in the Division of STD Prevention at the CDC. Her work focuses on STI clinical care, including guidance development for STI management in a variety of settings.
Biography
Claire Heyison, MPH, is a former Research Scientist at the George Washington University Milken Institute School of Public Health, Department of Health Policy. Her research focuses on policy approaches to improve health care access and affordability, particularly for people with low incomes.
Biography
Paige Organick-Lee, MPH, is a Research Associate at the George Washington University Milken Institute School of Public Health. Her research interests include reproductive care access and policies to address the social determinants of health.
Biography
Aaron Karacuschansky, MPH, is a Research Scientist at the George Washington University Milken Institute School of Public Health. He is experienced in conducting multi-state/payor coverage, reimbursement, and policy analyses relevant to chronic diseases.
Biography
Gregory Dwyer, MPH, is a Research Scientist at the George Washington University Milken Institute School of Public Health. His research expertise includes public and private insurance coverage, HIV/STIs, cardiovascular disease, mental health, substance use disorder, public health funding, and social determinants of health.
Biography
Alexis Osei, MPH, is a former Research Assistant at the George Washington University Milken Institute School of Public Health. She currently works as a Research Analyst at Altarum and is interested in global health research, with a particular focus on marginalized populations.
Biography
Helen Stoll, MPH, is an student at the George Washington University Milken Institute School of Public Health. Her areas of interest include quality reporting, value-based purchasing, post-acute care, health equity, and maternal and child health.
Biography
Katie Horton, JD, RN, MPH, is a Research Professor at the George Washington University Milken Institute School of Public Health. She has more than 30 years of public policy and research experience in health and the healthcare system.
Article info
Publication history
Published online: January 30, 2023
Accepted:
December 14,
2022
Received in revised form:
December 14,
2022
Received:
June 9,
2022
Publication stage
In Press Corrected ProofFootnotes
Funding Statement: The work of N.S., C.H., P.O.-L., A.K., G.D., A.O., H.S., and K.H. on this project was supported by the Centers for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.
Identification
Copyright
© 2022 Jacobs Institute of Women's Health, George Washington University. Published by Elsevier Inc. All rights reserved.
