The World Health Organization defines sexual health as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.” Far from having obtained a state of sexual well-being, the United States is in the midst of a sexually transmitted infection (STI) epidemic. More than half of all Americans will contract an STI in their lifetime. If untreated, STIs can lead to serious pelvic infections, infertility, and even death. Medicaid is the largest public payer of STI-related care, and the Affordable Care Act guarantees no-cost coverage for most STI screening. It also provides coverage for key gender-affirming care services that can include medical, surgical, mental, and other health care services that are critical for transgender and gender non-conforming people.
NHeLP’s work aims to increase coverage, screening, preventive care, and treatment for people at risk of, or living with, STIs, including HIV. We leverage administrative, legislative, and judicial advocacy to make policy gains such as: a judicial decision decrying the illegal practice of adverse tiering for HIV drugs; administrative inclusion of PrEP and external condoms as no-cost preventive services under the ACA; and passage of state bills allowing pharmacists to prescribe STI medication.
In addition, LGBTQI+ people face a myriad of barriers to sexual health, which encompasses issues of gender-identity and sexual orientation. Many LGBTQI+ people face discrimination in health care coverage and delivery. For example, some state Medicaid programs violate federal requirements for gender-affirming care coverage. Some health care providers refuse to see patients based on gender identity. NHeLP works to promote sexual health through litigation, policy advocacy, and legal technical assistance on Medicaid, the ACA, and related civil rights.
