While diagnostic COVID-19 testing is essential to containing and mitigating the pandemic, testing is inaccessible to low-income and marginalized communities -- especially people of color and undocumented immigrants -- the same communities that are being hit hardest by COVID-19.
Throughout our research, PHLP’s Community Navigators have identified common barriers to getting tested that disproportionately affect Pennsylvanians who are enrolled in Medicaid or uninsured. Most low-income Pennsylvanians are either Medicaid recipients or uninsured. COVID-19 testing is currently free for all Pennsylvanians on Medicaid, and no prior authorization is needed to be tested. Testing also is available for people who do not have health insurance, but it is not always free. However, free testing alone is not enough to ensure equitable access. In sharing our findings, we hope to increase awareness about the ways in which our current system limits access to COVID-19 testing for vulnerable populations.
The majority of testing sites throughout Pennsylvania require an appointment in order to get tested. Some sites only take appointments online, while others take appointments over the phone. Walk-ins are rarely welcome. This makes internet access and digital literacy a frequent prerequisite for getting tested, which disproportionately limits access for low-income and marginalized communities. Internet access is often needed to locate nearby testing sites, learn about their cost, hours, and requirements. Testing information changes frequently, and internet access is often necessary for up-to-date information. Additionally, many sites require patients to take an online assessment to determine if they are eligible to be tested, and send their test results via email or web portal.
Testing sites commonly require a referral from a Primary Care Provider (PCP) in order to get tested. This is particularly a barrier for people without health insurance, who are less likely to have a PCP to obtain a referral from, and more likely to incur a hefty fee from a PCP visit.
Many testing sites are drive-through only, meaning one needs access to a car in order to be tested. Drive-through only sites are particularly prevalent outside of Pennsylvania’s major cities of Philadelphia and Pittsburgh. When a car becomes a requirement for testing, that unjustly limits access for low-income individuals.
One obstacle becomes clear when searching for testing sites outside of Philadelphia and Allegheny counties -- options are few and far between, and even fewer are low-barrier options. For example, our team has identified eight testing sites in all of Dauphin County, and only two in downtown Harrisburg. Nearly all sites have requirements that may limit access for vulnerable populations, such as requiring a car, an appointment, or a PCP referral.
In our efforts to identify COVID-19 testing sites accessible to marginalized populations, PHLP’s Community Navigators have come across misinformation, incomplete information, and a general lack of available information. We have found sites that publicly promote free testing, only to discover through further digging that while the test itself is free, the visit costs upward of $150. Even when testing site information is accurate and available, it is not always easy to locate, user-friendly, or comprehensive. For example, a Google search or municipal website may list local testing sites, but not relay whether or not the site is free for those without health insurance. This again highlights how internet access and digital literacy can be a barrier to testing, as well as highlights the need for accessible resources geared toward vulnerable Pennsylvanians who are enrolled in Medicaid or uninsured.
In addition to the overarching barriers above, specific communities face unique obstacles and deterrents to getting tested for COVID-19. Fear of sharing personal identifying information among undocumented community members, historic distrust of the healthcare system among Black community members, and the lack of available resources for non-English speakers all present community-specific barriers to equitable testing. In order to increase access to testing for low-income and marginalized populations, it is essential to pay particular attention to the needs and experiences of these communities.
To mitigate these barriers to COVID-19 testing, PHLP’s Community Navigators are working to gather information on low-barrier testing sites throughout Pennsylvania and disseminate accessible resources geared toward our target populations. In addition to increasing the availability and accessibility of information, it is crucial to advocate for more low-barrier testing sites throughout the state. In order to promote health equity in this pandemic, we recommend more walk-in and walk-up testing sites, less reliance on provider referrals, more resources and services tailored to non-English speakers, and an increase in the number of testing sites located in high-need neighborhoods. We additionally recommend the continuation and expansion of free testing for Medicaid recipients and the uninsured. We call on Pennsylvania’s government entities, healthcare systems, and nonprofits to help fill the gap and ensure equitable access to COVID-19 testing for Pennsylvania’s most vulnerable communities.