Recipe for a Successful Medicaid Family Planning Program

The author of an opinion letter printed in the Wausau Wisconsin paper this morning was reacting to a reader’s letter that was supporting family planning. She said: “If by preventing unplanned pregnancies, he is referring to dispensing contraception, how does that prevent unplanned pregnancies?’

Like the majority of states, Wisconsin has a Medicaid Family Planning Waiver that expands access to routine preventive contraceptive and STD care. Overall, our program has been successful at reducing geographic gaps in access. By providing contraception, we are reducing unintended pregnancies, reducing teen pregnancies, and reducing the need for abortions – all at substantial savings to taxpayers. Wisconsin’s estimated five-year savings was $487 million. Best of all, for states with budget shortfalls, Medicaid Family Planning expansions provide $9 in federal funds for every $1 in state funds.

There is an enormous national opportunity before us and very little time to waste on efforts to reason with the irrational. Primary preventive health care delivery is changing and if we are to move closer to universal access to reproductive health care, reproductive health care providers and supporters must seize the opportunity. Federal health care reform law provides the 27 states with these expansions with an opportunity to strengthen their existing programs by requesting a permanent state plan amendment from the Centers of Medicare and Medicaid Services (CMS).  For the other 23 states and the District of Columbia, there is a parallel opportunity to begin providing these services.

In Wisconsin, we must move quickly to strengthen our program and solidify the gains we have made under the Doyle administration and we don’t need legislative action.  In eight months we will have a new governor and a new legislature. Even with a supportive administration, coordination and approval is not instantaneous.  So it is time to move ahead and get to work. Here are the terms  with which we will approach our Department of Health Services:

A successful Medicaid family planning program must contain these eligibility and coverage essentials:

Enrollment must be convenient

  • Presumptive eligibility must be available for provision of immediate (same day same site) contraceptives and STD services.
  • Full eligibility must be processed in a timely manner to avoid gaps in coverage and gaps in care.

Income eligibility must be broad.

Covered comprehensive services must include most contraceptive methods and Emergency Contraception.

Eligibility for students and minors must be based on their own income.

A successful Medicaid family planning program must contain these structural essentials:

  • A formally established state department-level work-group or council that brings key leadership in public health, family planning, and primary preventive health care together in an advisory capacity.
  • A written commitment to integrating and normalizing sexual health care and education by fostering public-private partnerships.
  • A clear commitment to the principal that all participants receiving Medicaid-paid health benefits have a right to choose a willing and qualified provider (including out-of-plan) for the reproductive health services they need.
  • A written assurance that reimbursement rates to reproductive health care providers will be sufficient to maintain statewide access to family planning services.

We are moving ahead right now to expand, improve, and strengthen our family planning program by negotiating a permanent state plan amendment based on what we have learned over the past seven years.  That federal contract will protect and solidify our program’s gains. With that protection, we will continue to answer the question “How does dispensing contraception relate to preventing unwanted pregnancies?” not so much with rhetoric, but with results.

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  • cat

    Medicaid pays for contraception and gynecologist appointments.  I get my pills through medicaid and I also know women who have recieved other birth control services (shot, IUD, etc) through medicaid.  Medicaid is good with covering STD testing and treatment as well as pregnancy related costs.  Yes, there are problems with certain coverage gaps and such, but that is a problem with getting medicaid, not a problem about services while on it.  The biggest reproductive health issue not covered by medicaid is abortion.  Prevention, STDs, and pregnancy costs are covered already.

  • lon-newman

    This varies from state-to-state, Cat. Now is the opportunity to fill those gaps in terms of family planning/std services, broaden eligibility (for example by increasing the income limits), expanding services that are covered, etc.  Also, if you have a very comprehensive program now and are capturing the 9:1 federal funding, you may want to ‘lock it in’ against the possibility that next year your political support for the program might change and your comprehensive program could be at risk.

    “Family planning” is not going to include abortion services, although some states do pay for what they define as ‘medically necessary’ terminations.


  • sandy-peterson

    Lon Newman has provided an informative blog and an important plan to provide and protect Wisconsinites with proper and affordable reproductive health care. I wholeheartily support Family Planning Health Services.