NFPRHA's Position As the largest payer of family planning care, Medicaid is critical to ensuring access to high-quality, confidential family planning and sexual health services and supplies for people with low or no incomes.

 

Medicaid funding of family planning care is critical to ensuring access to high-quality, confidential family planning and sexual health services and supplies for people with low incomes. 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. Federal law requires that Medicaid-funded family planning be exempt from cost-sharing and cover a broad range of family planning services, including the full range of contraceptive methods, Pap tests, and other associated examinations and labs. Federal law also requires that people with Medicaid coverage receive family planning services from any qualified provider willing to provide those services, which is a provision referred to as "freedom of choice.”

States have also broadened eligibility for their Medicaid programs to provide family planning care by either securing a family planning waiver, which is time limited, or a state plan amendment, which is a permanent change to the state’s Medicaid program.

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.

NFPRHA Fact Sheets

• Medicaid: A Cornerstone of Publicly Funded Family Planning Care - Fact sheet explaining the intersection of Medicaid and family planning.
• Medicaid's Free Choice of Provider Protections - An infographic advocating for enforcement of free choice of provider protections, especially in states which have illegally deprived benificiaries of their right to a family planning provider they trust.

NFPRHA Analysis

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

NFPRHA Letters 

• Joint Letter to CMS Administrator Chiquita Brooks-LaSure on Free Choice of Provider Enforcement - NFPRHA and 35 other national organizations issued a joint letter in response to recent actions that several states have taken to unlawfully prohibit abortion providers from participating in their Medicaid programs, in direct violation of federal law that ensures Medicaid beneficiaries have the right to seek family planning care from the provider of their choice. 
• Letter to CMS Administrator Seema Verma Opposing Approval of Texas Healthy Texas Women Waiver - NFPRHA and 15 other national organizations in opposition to the Trump administration’s approval of Texas Healthy Texas Woman waiver, which bars abortion providers, or any provider who affiliates with an abortion provider, from participating in the state’s Medicaid family planning expansion program.

NFPRHA Comments

• Maine 1115 Medicaid Family Planning Waiver
• Texas 1115 Medicaid Family Planning Waiver 
  
• Idaho 1115 Medicaid Family Planning Waiver
• "Healthy Texas Women Plus" 1115(a) Medicaid Waiver

Other Resources

• Medicaid & Reproductive Justice All* Above All, NAPAWF, National Institute for Reproductive Health, National Health Law Program, and In Our Own Voice: National Black Women's Reproductive Justice Agenda 
• Medicaid Demonstration Waivers & Reproductive Justice All* Above All, NAPAWF, National Institute for Reproductive Health, National Health Law Program, and In Our Own Voice: National Black Women's Reproductive Justice Agenda 
• Efforts to Transform the Nature of Medicaid Could Undermine Access to Reproductive Health Care, Guttmacher Policy Review 
• Advocates Guide to MAGI (Updated Guide for 2018), National Health Law Program 

CMS Links

• Letter to CMS Administrator Seema Verma Opposing Approval of Texas Healthy Texas Women Waiver - NFPRHA and 15 other national organizations in opposition to the Trump administration’s approval of Texas Healthy Texas Woman waiver, which bars abortion providers, or any provider who affiliates with an abortion provider, from participating in the state’s Medicaid family planning expansion program.
• State Medicaid Director letter - Clarifying and updating CMS budget neutrality requirements for Medicaid 1115 waivers 
• State Medicaid Director letter - Rescinding guidance from April 2016 which clarified Medicaid’s “free choice of provider” requirement in conjunction with state actions against Medicaid providers.
• Informational Bulletin - State Medicaid payment approaches to improving long-acting reversible contraception (LARC) access.
  
• State Medicaid Director letter - Rescinded guidance clarifying Medicaid’s “free choice of provider” requirement in conjunction with state actions against Medicaid provider.
  
• State Health Officials letter - Providing guidance on family planning services provided under both fee-for-service and managed care delivery systems.

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.

• Memo: NFPRHA Guidance on Medicaid Family Planning Waivers 
• Memo summarizing CMS' guidance on family planning SPAs

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