The Centers for Disease Control and Prevention recommends six strategies to reduce the spread of HIV and STD's. Only one of 32 rural states has all six policies in place and less than one-third have four or more of the six recommended policies in place. 

Rural households have worse health outcomes than urban households. Access to care is limited due to less insurance coverage, financial hardship and geographical access to care. Highlighted state policies address increasing the health care workforce in rural areas.

Federal health reform expanded private health plan coverage for preventive services that can keep people healthy, save lives and reduce health care costs, which many Americans do not receive. Starting Jan. 1, 2011, new group and individual private health plans are required to cover recommended preventive services, and patients do not have copayments or deductibles when in-network providers are used. To prevent sexually transmitted diseases and HIV/AIDS, covered services include screening tests, prevention counseling and immunizations. Coverage for preventive services by Medicare and Medicaid is also expanded.

All but two states maintained or improved eligibility rules for their Medicaid and Children’s Health Insurance Program, commonly known as CHIP, in 2010.These programs continued to be critical to providing insurance coverage for children and families that otherwise would be uninsured. The median state income limit for children’s coverage is now above 200 percent of the FPL, and pregnant women are eligible up to a median of 185% FPL. However, the median income limit for adult coverage is significantly below the higher eligibility level of 133% FPL that will be implemented under health reform in 2014.

The U.S. ranked behind 29 other nations in infant mortality in 2005. Experts believe the poor U.S. ranking is due in large part to disparities that continue to exist among various racial and ethnic groups, especially African-Americans. African-American babies are more than twice as likely to die in their first year as white babies. Low birth-weight and pre-term births are risk factors for infant mortality, but there is little consensus about why babies are born too soon or too small, or why racial and ethnic disparities persist.

The majority of state Medicaid programs are testing models of coordinated medical care to improve quality and reduce costs, particularly for patients with multiple chronic illnesses.  Patient-centered medical homes are similar to managed care approaches and health maintenance organizations, but ask providers to focus on improving care rather than managing costs. Such medical homes focus on improving the relationship between doctors and patients, aim to put the patient at the center of the care system, and provide coordinated and integrated care over time and across care settings. Descriptions of eleven states’ pilot programs or authorizing legislation are included.

With the recent federal policy change allowing use of federal funds for needle exchange programs, there is renewed focus on cost-effective public health syringe services programs to prevent HIV and hepatitis C infections and to reduce disparities. State law modifications to allow syringe services programs are described.

Expedited Partner Therapy (EPT), a cost-effective policy for treatment of curable sexually transmitted diseases, is legal in 23 states. EPT is one approach to treating sexual partners of patients diagnosed with chlamydia or gonorrhea infections, where patients provide treatment directly to their partners.