WASHINGTON — Twenty-one states have found alternatives to extend eligibility for family planning services while saving Medicaid dollars, a health policy expert said during a Kaiser Family Foundation briefing on women and Medicaid.
One-third of all U.S. women of reproductive age who are under the poverty level depend on Medicaid for their health care, putting it “front and center of providing critical reproductive services,” said Rachel Gold, director of policy analysis at the Alan Guttmacher Institute.
Under one approach, 13 of the 21 states have extended eligibility for Medicaid family planning benefits to women based solely on their income. Women who never had any association with Medicaid would be eligible for this benefit, she said. Of the 13 states, 7 extended the coverage to men, providing access to condoms, testing and diagnosis for sexually transmitted diseases, and vasectomies.
In a study of six of these income-based Medicaid expansions, the Centers for Medicare and Medicaid Services found that the programs met the budget neutrality requirement. In addition, the programs also saved money for the Medicaid program as a whole, because “the cost of providing family planning under these programs is far less than the cost of providing the maternity services that would have been necessary in the absence of these programs,” Ms. Gold said.
Although Medicaid has covered newborns through a 60-day postpartum period, that coverage has never been extended to the mother, Ms. Gold said. “Many states have thought this didn't make sense, and six have tried experiments where you leave the woman on Medicaid for generally up to 2 years for family planning only.”
Illinois and Delaware went so far as to extend Medicaid coverage for family planning to women who would be losing full Medicaid coverage for any reason.
Since starting these programs, data show that more women with expanded coverage have been getting family planning services than when these services were offered in clinics, Ms. Gold said.
Family planning is one of a handful of services that state programs must cover under a federal mandate. “The federal government reimburses states 90 cents on the dollar for their expenditures for family planning. That's a higher reimbursement rate than for any other medical service under Medicaid,” she said. In 2001, the most recent year for which there are data, Medicaid contributed $770 million for family planning services and supplies.
Medicaid recipients who obtain family planning services cannot be charged any copays or incur out-of-pocket costs.
Individuals enrolled in Medicaid managed care plans can obtain family planning services with the provider of their choice, “regardless of whether that provider is affiliated with the person's managed care plan,” she said. Most states cover a fairly wide range of contraceptive methods, including condoms, “even though condoms are a nonprescription method.”
Tubal ligation and vasectomy are covered as family planning services in all state Medicaid programs. By comparison, gynecologic exams and tests and treatment for sexually transmitted diseases are covered by Medicaid, but not always as family planning services. “This is important from the woman's perspective, because then you might have to pay copays or not have the freedom to choose your provider” for these services, Ms. Gold said.
Eligibility for maternity care has greatly increased because of expansions granted by Congress and the states. Medicaid currently pays for 4 in 10 births nationwide, and in four states—Alaska, Mexico, West Virginia, and Mississippi—the program pays for more than half the births.
Abortion funding no longer applies to Medicaid unless the woman's life is in danger or she's the victim of rape or incest. “The federal government pays for just a handful of abortions under these restrictions every year, and most states have adopted parallel restrictions,” she said.
Seventeen states continue to use their own funds to provide abortion services to Medicaid enrollees, Ms. Gold said.
Snapshot: Women Medicaid Recipients
The vast majority of women on Medicaid are in their reproductive years, although they're not the most expensive population to treat, Alina Salganicoff, Ph.D., vice president and director of women's health policy for the Kaiser Family Foundation, said at the briefing.
“The elderly and disabled account for two-thirds of the spending because of [their] greater health needs and more costly medical and long-term care,” Ms. Salganicoff said. On average, a low-income adult on Medicaid, typically a mother, costs about $2,000 a year to treat, whereas a disabled elderly beneficiary costs about $12,000 a year to treat.
Women comprise more than 70% of the adult Medicaid population and are more likely than men to qualify because of their lower incomes and status as single, low-income parents of children, she said.