“…The barriers in accessing genetic services are numerous: genetics providers tend to be concentrated in urban areas or academic medical centers, the workforce is small and unevenly distributed, and insurance providers often limit coverage for genetic testing and genetic counseling (Cooksey, Forte, Benkendorf, & Blitzer, 2005; Graf, Needham, Teed, & Brown, 2013; Secretary’s Advisory Committee on Genetics Health Society, 2006; Wang, Beattie, Ponce, & Phillips, 2011). State Health Agencies (SHAs) have historically sought to mitigate some of these barriers by providing clinical services (such as genetic testing or genetic counseling) directly, contracting with healthcare providers to provide care, or sharing these responsibilities with private payers and charities (Epstein, Erickson, Hall, & Golbus, 1975; Kelly, 2002; Lessick & Townes, 1979; MacDonald, Blazer, & Weitzel, 2010; Reid et al, 1976). SHAs have myriad other responsibilities, however, and the provision of direct clinical services makes up a very small proportion of their activities.…”