Medicaid

Medicaid funding of family planning care is critical to ensuring access to high-quality, confidential family planning and sexual health services and supplies for poor and low-income individuals. Medicaid has been the predominant funding source (75%) for publicly funded family planning care since the 1980s, particularly in states that have expanded their Medicaid eligibility for family planning. Medicaid’s importance in providing publicly funded family planning care has continued to grow under the Affordable Care Act (ACA), as many states have expanded their Medicaid programs to Americans with incomes up to 138% of the federal poverty level (FPL).

Medicaid-funded family planning is proven to save taxpayer dollars by expanding access to contraception and increasing women’s use of more effective contraceptive methods - essential factors in reducing high rates of unintended pregnancy among low-income women. Federal law requires that Medicaid-funded family planning be exempt from cost-sharing requirements, such as deductibles and co-pays, and provides that most Medicaid managed care enrollees can receive family planning services from any provider (a provision referred to as "freedom of choice"), even if their provider of choice is outside of their managed care network.

NFPRHA's Work

NFPRHA works on federal policy and with its membership on state policy to protect, expand access to, and improve policies related to Medicaid-funded family planning.

Resources

NFPRHA Analysis

  • CMS Advancements in Medicaid Family Planning (PDF) – Analysis of new CMS regulations and sub-regulatory guidance that clarify and strengthen existing requirements governing the provision of family planning services and supplies under Medicaid (August 2016).

NFPRHA Fact Sheets

 NFPRHA's Position
 

Medicaid
NFPRHA believes that Medicaid funding of family planning and sexual health is critical to ensuring access to high-quality, confidential family planning and sexual health services and supplies for poor and low-income patients.

Happening Now 

  • The Centers for Medicare & Medicaid Services (CMS) continues to consider and approve waivers to state Medicaid programs that seek to impose harmful restrictions and requirements that limit Medicaid eligibility and access to care.

NFPRHA Letters 

NFPRHA Comments

Other Resources

CMS Links

  • State Medicaid Director letter (PDF) - Clarifying and updating CMS budget neutrality requirements for Medicaid 1115 waivers (August 22, 2018)

  • State Medicaid Director letter (PDF) - Rescinding guidance from April 2016 which clarified Medicaid’s “free choice of provider” requirement in conjunction with state actions against Medicaid providers (January 19, 2018)

  • State Medicaid Director letter (PDF) - Outlining new policy from CMS regarding its willingness to approve Medicaid 1115 waivers which impose work requirements on beneficiaries (January 11, 2018)

  • Informational Bulletin (PDF) - State Medicaid payment approaches to improving long-acting reversible contraception (LARC) access (April 8, 2016).

  • State Medicaid Director letter (PDF) - Clarifying Medicaid’s “free choice of provider” requirement in conjunction with state actions against Medicaid providers (April 19, 2016).

  • Final rule on managed care for Medicaid and the Children’s Health Insurance Program (CHIP) (PDF) - The rule, while broadly affecting family planning services and providers, includes specific policy enhancements and updates to program rules specific to family planning services and supplies (April 25, 2016).

  • State Health Officials letter (PDF) - Providing guidance on family planning services provided under both fee-for-service and managed care delivery systems (June 14, 2016).

Family Planning State Plan Amendments & Waivers

All states provide family planning services to Medicaid enrollees, and many states have expanded their Medicaid coverage of family planning to childless adults through a Section 1115 demonstration waiver from CMS. States also have the option to extend coverage for family planning services and supplies through a state plan amendment (SPA) rather than a waiver.

For additional resources & information, access NFPRHA fact sheets and federal comments by issue or read NFPRHA's publications and recent press statements.

Page last updated November 6, 2018

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