Low-Income Women's Access to Family Planning

31 states, as of October 2012, provided expanded access to Medicaid coverage for family-planning services.

• 23 states provide expanded access to Medicaid-funded reproductive-health services through a waiver obtained from the federal government: AL, AZ, AR, DE, FL, GA, IL, IA, LA, MD, MI, MN, MS, MO, MT, NY, NC, OR, PA, RI, TX, WA, WY.
• 8 states provided certain low-income women coverage for Medicaid-funded reproductive-health services through a SPA: CA, IN, NM, OK, OH, SC, VA, WI.

Title X of the Public Health Service Act grants federal funds to family-planning clinics that provide reproductive-health services to low-income women, uninsured women, and women who cannot qualify for Medicaid. For many women, Title X clinics provide the only basic health care that they receive.

The ACA allows states to improve access to family-planning care without requiring prior federal approval by amending their Medicaid plans to create a new eligibility group of low-income individuals through a SPA. This option allows states to offer women who otherwise would not qualify for the Medicaid program access to Medicaid family-planning services.

Under the ACA, newly issued insurance plans must cover women’s family-planning care, including all Food and Drug Administration-approved contraceptive methods, without a copay or deductible. This new policy reduces financial barriers to contraception for millions of low- and middle-income women with health insurance.

2 states enacted 3 measures expanding access to family planning for low-income women and men: IN, VT.

2012 saw two major debates in Congress over the issue of contraceptive coverage:

Congress again attempted to zero out all funding for Title X, the nation’s cornerstone family-planning program. Although the Senate Appropriations Committee approved a bill in June funding Title X with only a slight decrease over the previous year’s level, anti-choice members of the House redoubled their efforts to gut this vital program. For the third time in as many fiscal years, the FY’13 draft spending bill released by anti-choice House leadership in July eliminated all funding for the Title X family-planning program and prohibited Planned Parenthood from receiving any federal funds, including family-planning grants. At the time of publication, neither the House nor Senate has acted on these proposals.

As part of the ACA, the Obama administration enacted a policy requiring all insurance plans issued on or after August 1, 2012, to cover women’s family-planning services, including the full range of Food and Drug Administration-approved contraceptive methods, without a copay. The rule, issued in January, has an exception for houses of worship and also clarifies that women who work at religiously affiliated hospitals, universities, and organizations may not be denied the benefit – but in those instances where the organization opposes contraception, the health plan must provide the service directly to beneficiaries. (See Refusal to Provide Medical Services page for more details.)

In National Federation of Independent Business et al. v. Sebelius, the Supreme Court largely upheld the constitutionality of the Affordable Care Act but struck down a key provision that would have covered more low-income people in the Medicaid program. (Note: this Medicaid expansion differs from the SPAs described earlier in that it would have required states to cover individuals for all health services, not just family-planning care.) Effectively, the ruling bars the federal government from requiring states to expand their Medicaid programs to cover more low-income people, rendering the expansion optional. As a consequence, the ruling likely will somewhat limit the law’s promise of improved access to comprehensive health care – including reproductive-health services – for low-income people in states that refuse to participate.

Following last year’s decimation of Texas’ family-planning budget, this year nearly 150 family-planning clinics have lost state funds and more than 60 clinics have closed permanently. The acute shortage of publicly funded family-planning care has been compounded by the impending expiration of Texas’ Women’s Health Program, which has been funded by a Medicaid family-planning expansion waiver. The waiver could not be renewed because the state violated its legal requirements by barring health centers that provided or referred for abortion from participating. Texas has issued conflicting statements regarding whether it will support the Women’s Health Program without federal funding. At the time of publication, the program remains operational pending a court decision in Texas’ legal challenge to the federal Medicaid law.

Nebraska considered a bill that would expand Medicaid family-planning services through a waiver and provide coverage for more than 25,000 women. Rather than support this reasonable legislation, anti-choice lawmakers attached a poison-pill amendment to bar any health center that provides or refers for abortion services from participating. The bill failed, and Nebraska remains without an expanded women’s health program.

Pro-choice lawmakers in New Jersey again introduced a bill to restore the state’s family-planning budget, eliminated in 2010. Anti-choice Gov. Chris Christie (R) once again vetoed it, leaving the state without a family-planning account for the third year in a row. The legislation also included a provision which would have allowed the state to offer Medicaid family-planning coverage to more women through a SPA.