Medicaid & Family Planning

Medicaid, the joint federal-state program adopted in 1965 as part of the Social Security Act, now funds health services for more than 55 million low-income Americans. For the past 25 years, it has also been the largest public source of financial support for family-planning services and supplies in the nation. Seven in 10 Medicaid enrollees older than 14 are women, as they tend to be poorer than men and more likely to meet all the program's criteria for eligibility, according to the Henry J. Kaiser Family Foundation.

Family Planning's Special Status

• When the Medicaid program was first enacted, states could choose whether to cover family planning or not. After several years, however, administrators began to realize that unplanned childbearing was likely to have dire social and economic consequences. As a result, Congress amended the program in 1972 to require all states to offer family-planning services and supplies to all Medicaid beneficiaries of childbearing age. The Kaiser Family Foundation reports that although states have discretion over what general prescription drugs they will cover, contraceptives are mandated to be provided as family-planning supplies. As an incentive, the federal government agreed to pay 90 percent of the family-planning costs, rather than the 50 to 75 percent usual scale based on the per capita income of state residents.

State Eligibility Expansions

• Medicaid was again amended in early 2006 when Congress passed the Deficit Reduction Act of 2005 (DRA). This act allowed states to re-structure their Medicaid programs to be more inclusive in the family-planning area. To do so, states sign a waiver of federal policy with the Centers for Medicare and Medicaid, according to the Guttmacher Institute. At present, 27 states have waivers in place. Some states have expanded Medicaid coverage for women who would have otherwise lost benefits after 60-days postpartum, since state Medicaid pregnancy coverage normally ends 60 days after the birth. Others have raised income limits to include individuals who would not have been eligible under general Medicaid requirements.

Range of Family Planning Services Covered

• Counseling services and patient education are universally available. Virtually all states also cover oral contraceptives and gynecological examinations. Thirty-nine states pay for condoms through Medicaid, and 35 allow testing for sexually transmitted diseases. Nearly all Medicaid programs cover tubal ligation for women and vasectomy for men, according to the Kaiser Family Foundation. Federally funded sterilizations carry provisions: informed consent is necessary, as is a 30-day waiting period. Anyone younger than 21 or mentally competent is barred from sterilization. Since family planning is not only concerned with prevention, federal guidelines also allow coverage of infertility services, including reversals of sterilization.

Effects of the Present Economic Situation

• When faced with diminished finances, many families cut health spending, including the monthly expense of contraceptives. Yet if an unplanned pregnancy occurs, the family probably will be in even worse financial shape. The National Women's Law Center in Washington, D. C., which is working for Medicaid family planning expansion in all states, reports that a poor woman in the United States today is close to four times as likely to have an unplanned pregnancy as a more affluent woman.

The Medicaid Family Planning Project

• The National Women's Law Center has launched a project to offer technical assistance to state governments to aid in negotiating the process, which is growing increasingly difficult, to secure a family planning waiver. According to the center, the complete bureaucratic process takes an average of two years. If each state took the option of expanding family planning services coverage under Medicaid, the group contends that it would extend eligibility to an additional 3 million low-income women.