States Extend Medicaid Family Planning Services


WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving money for the Medicaid program, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.

This is encouraging news at a time when everyone's so concerned about budget cuts and, specifically, cuts to Medicaid, Rachel Gold, director of policy analysis at the Alan Guttmacher Institute, a health policy research organization in Washington, said during the briefing.

One-third of all U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” Ms. Gold said.

Under one cost-saving approach, 13 of the 21 states have extended Medicaid eligibility for family planning to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said.

Seven of the 13 states extended the coverage to men, providing them with access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.

In authorizing these experimental eligibility expansions, the federal government requires that these programs remain budget neutral—“meaning they can't cost the government any more than what it would have spent in the absence of one of these programs,” Ms. Gold said.

In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement.

In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.

Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only,” she said.

Two states, Illinois and Delaware, went so far as to extend Medicaid coverage for family planning to those women who would be losing full Medicaid coverage for any reason.

Since the establishment of these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.

Family planning has a special status under Medicaid, as it's one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” Ms. Gold said.

In 2001, the most recent year for which data are available, Medicaid contributed $770 million for family planning services and supplies.

Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.

Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”

Tubal ligation and vasectomies are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for sexually transmitted diseases are covered by Medicaid, although they're not always considered family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said during the briefing.

Eligibility for maternity care has greatly increased because of a series of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, New Mexico, West Virginia, and Mississippi—the program pays for more than half the births.

Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.

Seventeen states in the meantime continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.

A Snapshot of Women Medicaid Recipients

The vast majority of women on Medicaid are in their reproductive years, although they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.