For states with family planning waivers, many dollars at stake

Family planning waivers have allowed Medicaid programs in 28 states to benefit from the 90% federal matching rate for people who would not otherwise be eligible for those services, notes E. Kathleen Adams, PhD, professor of health policy and management at Emory School of Public Health in Atlanta.

"With these expansions, the percentage of publicly funded family planning services that are Medicaid-financed has really been growing," she says. This means that defunding Planned Parenthood, as a growing number of states are attempting to do, has significant fiscal implications for states with family planning waivers, says Dr. Adams.

In many states, Planned Parenthood is the Title X provider involved in these waivers, which have a separate source of federal funding for family planning, adds Dr. Adams. "If you are restricting the set of providers to which women eligible for Medicaid can go to, you really are putting at risk their access to, and the volume of, family planning services which will be matched at 90%," she says.

A lot of dollars are at stake for the 28 states with family planning waivers, says Dr. Adams, making it unlikely they will defund Planned Parenthood. "States with large waiver programs wouldn't think of such a thing because they have a large amount of federal funding and program participants," she says. "States are very convinced that there are plenty of dollars saved, due to reductions in unintended pregnancies and better outcomes."

When Medicaid family planning waivers are used, adds Dr. Adams, the state's total amount of family planning services grows significantly. "That's what you want. You want it to grow and your Title X dollars not to shrink, so you have actually expanded access to family planning services for low-income women," she says.

Indiana, North Carolina, Wisconsin, and Kansas defunded Planned Parenthood in their 2011 legislative sessions because some of the organization's clinics provide abortions, notes Dr. Adams, but she doesn't believe these actions will hold up in court.

Dr. Adams notes there was some debate, as the health care reform legislation evolved, over whether family planning should be considered a preventive care service provided with no copay.

After a July 2011 report from the Institute of Medicine, Clinical Preventive Services for Women: Closing the Gaps, recommended that birth control and contraceptive counseling be fully covered by health plans, the Obama administration is requiring that health insurance plans cover birth control as preventive care for women, with no copays, effective as of January 1, 2013. "There is no question that this issue is treated as a political football," says Dr. Adams.