Low-income women may soon lose access to low-cost or free family planning.
Women in five states may be without affordable access to important health and family planning services, including routine cancer screenings and contraception, as key programs expired at the end of last year.
Medicaid waiver programs in Illinois, Michigan, Pennsylvania, Oregon, and Louisiana previously provided family planning services at little or no cost. But these programs came to an end on December 31st, leaving previously enrolled women (and, in the case of Michigan, men) without the low-cost reproductive health services that they have come to rely upon for years.
Medicaid waiver programs, or “demonstrations,” allow states to test new means of delivering health coverage under Medicaid, or to expand coverage to individuals who would not otherwise be eligible under federal law. States must apply to the federal Centers for Medicare & Medicaid Services (CMS) for approval of these waiver programs, and they must reapply every three years to renew the federal government’s approval. But the state governments of five states that had been running family planning assistance programs under approved waivers chose not to ask CMS to renew their programs.
Waiver renewal applications are open to public comment. Some states, like California, have transitioned their family planning waiver programs into State Plan Amendments (SPA) instead. SPAs amend a state’s Medicaid state plan – an agreement between the federal government and a state that describes the state’s Medicaid program. Unlike waiver programs, SPAs do not require renewal; states only need to ensure their Medicaid programs comply with federal laws in order to receive federal matching funds.
Eligibility guidelines for family planning waiver programs vary slightly from state to state, but generally they cover women with incomes that do not exceed a certain amount above the Federal Poverty Level (FPL), but who do not qualify for Medicaid. The purpose of these waiver programs is to provide low-cost reproductive services to women who do not qualify for Medicaid, but who are either uninsured or whose health insurance plans do not cover these services.
Now that Illinois, Louisiana, Oregon, Michigan, and Pennsylvania have eliminated the waiver programs, previously enrolled beneficiaries will have to reapply for alternate health insurance if they wish to receive family planning benefits.
Four of these states – Illinois, Oregon, Michigan, and Pennsylvania – have expanded Medicaid under the Patient Protection and Affordable Care Act, known as “Obamacare,” to include adults with incomes up to 138% of the FPL. This means that most former beneficiaries of waiver programs in those states will likely receive the same low-cost services under Medicaid, but their enrollment will not be automatically transferred and they must reapply. Former waiver enrollees that are not eligible under Medicaid expansion may apply for healthcare through the Health Insurance Marketplace established under Obamacare, and could be eligible for federal subsidies to help them pay for coverage.
Louisiana is not expanding Medicaid at this time, meaning that all former waiver program participants must look to the insurance marketplace or other options for coverage.
Women’s health advocates worry that cancelling waiver programs and requiring women to reapply for health insurance will create gaps in coverage and leave many low-income women without necessary reproductive services.
The Pennsylvania Women’s Health Caucus, for example, urged the Pennsylvania Department of Human Services to apply for an extension to its SelectPlan for Women program, which would have allowed the state to continue providing low-cost family planning services to nearly 90,000 women through the end of 2015.
Advocates especially question states’ inability to transfer eligible women from the waiver programs to Medicaid automatically. Community Legal Services of Philadelphia, a non-profit providing free legal services for low-income residents, expressed concerns that the state’s failure to transfer eligible women from the SelectPlan for Women to the Medicaid expansion program automatically will create confusion among applicants, impose unnecessary administrative burdens, and lead to gaps in coverage for pregnant and non-pregnant women.
Participants in the Illinois Healthy Women program, like those enrolled in Pennsylvania’s SelectPlan for Women, ceased receiving benefits at the beginning of this year, and must reapply through Medicaid or the Health Insurance Marketplace.
Michigan originally sought to cancel its Plan First! program on June 30, 2014, about three months after implementing its Medicaid expansion program. But after a federal court ordered the state to extend Plan First! for women who had not yet had the opportunity to secure other Medicaid coverage, Michigan renewed through the end of 2014.
Louisiana has not expanded Medicaid, nor did it apply for waiver renewal with CMS to extend its Take Charge Plus program after 2014. Oregon has expanded Medicaid, but did not apply for renewal of its family waiver program.
According to the Kaiser Family Foundation, a non-profit organization focusing on national health issues, as of 2014, 13 states covered family planning through Medicaid SPAs and 16 states had family planning Medicaid waiver programs. Arkansas’ family planning waiver expired in December 2013, but it has expanded Medicaid under Obamacare. Programs in Alabama, Florida, Georgia, Missouri, Mississippi, Montana, and Wyoming were also set to expire on December 31, 2014, but these states currently have renewal applications pending with CMS. Illinois, Michigan, Pennsylvania, Oregon, and Louisiana were the only five waiver programs to expire at the end of 2014. Minnesota, Washington, Iowa, Maryland, and Rhode Island have waiver programs set to expire between 2015 and 2018.
Texas is the only state with an exclusively state-funded family planning program. Texas lost its waiver funding after it passed a law prohibiting taxpayer money from going to any organizations that provide abortion services, thus excluding Planned Parenthood from participating in the waiver program. CMS refused to renew Texas’ family planning waiver, because Federal law prohibits states from restricting a woman’s ability to choose from among qualified providers.