What Is Family Planning Services For Medicaid

An updated version of this report was released on February 17, 2022 and tin be plant hither.

Overview

Medicaid plays a major office financing family unit planning services for low-income women in the United States. Family planning services are "mandatory" benefits under Medicaid and must exist provided to individuals of childbearing historic period complimentary of price-sharing. At that place is, however, no formal federal definition of "family planning," which has given states considerable discretion to determine the specific services covered under this benefit. Furthermore, a state may found different coverage requirements for Medicaid funded family planning services for dissimilar eligibility pathways. The Affordable Care Act (ACA) created a new Medicaid eligibility category which has federally-specified coverage requirements for aspects of family planning (contraceptives, screening services, and counseling), but these requirements practise non apply to traditional Medicaid available prior to the ACA. This has magnified the potential for variations in coverage standards for unlike Medicaid eligibility pathways (e.k. traditional Medicaid available prior to the ACA, ACA Medicaid expansion, or Medicaid Family Planning Expansion program) within a state. The multiple pathways and coverage options brand it difficult to assess coverage differences for family planning services both within and across states nether fee-for-service.

This report presents findings from a state-level survey on states' family unit planning benefits under Medicaid, as of July 2015. The survey queried states about their coverage policies under fee-for-service for the following family planning services: reversible contraceptives, sterilization services, fertility diagnosis and handling, services related to family unit planning and sexual health such as cancer treatment and partner violence, and managed care policies. The survey identifies differences between states as well as within states betwixt Medicaid eligibility pathways: traditional Medicaid (available pre-ACA), Medicaid expansion under the ACA, and family planning-only coverage through a state Medicaid waiver or State Programme Subpoena (SPA). All 50 states and the District of Columbia were invited to reply to the survey, but data are presented for forty states and the District of Columbia that provided responses (Figure one). Throughout the report, DC is counted equally a country, totaling 41 respondents.

Figure 1: State Medicaid Eligibility Pathways for Women

Effigy i: State Medicaid Eligibility Pathways for Women

Key Findings

Reversible Contraception

All responding states cover nearly all prescription contraceptive methods approved by the Nutrient and Drug Administration under their fee-for-service programs, including IUDs and implants (Table 1).¹ Coverage of over-the-counter contraceptives, peculiarly emergency contraception, showed more variation and utilization controls. Near states, just not all states, accept aligned their coverage of prescription contraceptives beyond all of their Medicaid eligibility pathways.

Thirty-six out of 41 states covered all prescription methods in the survey under their traditional Medicaid pathway. Of the five states that did not cover all methods, 2 states did not cover i form of injectable and three of them did non cover ella, an emergency contraceptive pill.
While most contraceptives are covered, a number of states use utilization controls such as quantity limits on oral contraceptives and injectables. Some states, still, have moved in the opposite direction, permitting clinics to dispense a 12-month supply of oral contraceptives.
Coverage of IUDs and implants is widespread and no states reported that they express access to long-interim reversible contraceptives (LARCs) by requiring prior dominance, although some accept utilization limits nether fee-for-service, such as limiting coverage to certain brands.
States are considering and adopting a variety of payment policies to facilitate postpartum LARC While maternity services are typically paid for with a global fee that includes postpartum care, some states take developed a separate payment outside the global fee to compensate clinicians and hospitals for postpartum LARC insertions. Several states continue to include either the device or clinician fee in the maternity global fee, which can exist a disincentive for providers to insert postpartum LARCs given the relatively higher costs of IUDs and lack of separate reimbursement for the insertion.

Tabular array ane: Summary Findings on State Coverage of Contraceptive Methods in Traditional Medicaid Programs
Covers 20 forms of prescription contraceptives in Traditional Medicaid Program (36/41 states)	AK, AR, AZ, CO, CT, DC, DE, GA, HI, IA, IL, IN, KY, MA, MD, MI, MN, MO, MS, MT, NC, NE, NH, NM, NV, NY, OH, OK, OR, TN, TX, VA, VT, WA, WV, WY 5 states that practice not cover all methods: CA, ME comprehend all methods except Injectable- subcutaneous AL, ID, SC cover all methods except ella emergency contraceptive
Cover 3 forms of LARC in Traditional Medicaid Plan (41/41states)	AL, AK, AZ, AR, CA, CO, CT, DE, DC, GA, Hello, ID, IL, IN, IA, KY, ME, MD, MA, MI, MN, MS, MO, MT, NE, NV, NH, NM, NY, NC, OH, OK, OR, SC, TN, TX, VT, VA, WA, WV, WY
Covers 2 forms of Emergency Contraception in Traditional Medicaid Plan (35/41 states)	AK, AR, AZ, CA, CO, CT, DC, DE, GA, Hi, IA, IL, MA, Physician, ME, MI, MN, MO, MT, NC, NE, NH, NM, NV, NY, OH, OK, OR, TN, TX, VA, VT, WA, WV, WY
Covers 4 forms of OTC contraceptives Traditional Medicaid Plan (22/41 states)	AK, AZ, CA, DC, HI, IA, IL, MA, MD, MI, MN, MT, NE, NH, NM, NV, NY, OH, OK, VA, WA, WY
NOTES: Prescription contraceptive methods in this survey are: Copper IUD, Hormonal IUD, Implant, Injectable- intra-muscular, Injectable- subcutaneous, Diaphragm, Contraceptive Patch, Vaginal Ring, Oral Contraceptive Pills Combined, Oral Contraceptive Pills- Progestin But, Oral Contraceptive Pills-Extended Utilize, ella Emergency Contraceptive Pills, Tubal Ligation- General, Tubal Ligation- Mail service Partum, Sterilization Implant, and Vasectomy. LARC methods in this survey are: Copper IUD, Hormonal IUD, and Implant. OTC contraceptive methods in this survey are: Male condom, spermicide, sponges and levonorgestrel emergency contraceptive pills.

Coverage for emergency contraception (EC) pills, peculiarly the over-the-counter (OTC) production (levonorgestrel, as well known as Plan B), is non as uniform as for the prescription method (ulipristal acetate, likewise known equally ella). While at least one form of EC pills is covered in traditional Medicaid programs in most states, the OTC option is covered in fewer states and discipline to greater utilization controls, sometimes requiring a prescription. Three states study that they do not cover either type of EC pills. All states reported that they comprehend the copper IUD, which can be used as an EC, in all of their pathways.
Variation in coverage across the states was nearly notable for over-the-counter (OTC) contraceptives, including condoms and Plan B emergency contraception. Coverage for OTC supplies as well varied across country Medicaid eligibility pathways, and a number of states crave prescriptions for coverage, which creates an access barrier for products the FDA has deemed to be safe and effective for over-the-counter use.

Sterilization and Fertility Services

Most states cover sterilization services in their FFS program, just few pay for fertility services. Federal law specifies that states must cover surgical and implant sterilization procedures for women under ACA Medicaid expansion, and all of the responding states reported that they cover these procedures in traditional Medicaid besides.

Medicaid family planning expansion program do not always pay for sterilization services for women.
While all states reported they encompass vasectomies under traditional Medicaid, not all comprehend the process in their family planning expansion programs or nether their full scope Medicaid expansion programs.
Very few states cover diagnostic testing related to fertility, including laparoscopy for women and semen assay for men.
Only one state covers fertility treatments for either women or men, but this is restricted to individuals who accept infertility as a symptom of separate medical problem.

Family Planning-Related Services

The definition of high quality family unit planning encompasses a wide array of services including screening and treatment for cervical and breast cancers, interpersonal violence screening and prevention, and sexual health counseling. These family planning-related services, notwithstanding, are less consistently covered by family planning expansion programs than contraceptives.

Although breast cancer screening is considered "optional" nether traditional Medicaid, it is a required benefit in ACA Medicaid expansion programs. All responding states provided breast cancer screening services under these ii full scope eligibility pathways. Few states, yet, provide this do good through their family planning waiver or SPA.
All states embrace Pap screening for cervical cancer regardless of eligibility pathway, only follow-up tests for abnormal screening results are less likely to be covered in land family planning waivers or SPAs.
HPV vaccines for young adults are covered in all simply one country, but the do good is less likely to be covered through a family planning expansion programme.
Contraceptive counseling and screening for intimate partner violence are covered by most states, but services are typically subject to restrictions and are not ever covered for all eligibility pathways bachelor within a state.

Managed Care Policies

The majority of states have capitated managed care contracts that include family planning services. Many of these states, however, do not address how utilization controls can be used in the context of family planning in their contracts. Some of usa noted that they contract with MCOs that include providers with religious objections to family planning in their networks, but not all of these states detailed referral processes to assure that women can become family planning intendance from other providers.

Most of the responding states have capitated contracts that include family planning in the capitation rate. Only over one-third of these states explicitly address potential utilization controls on family planning services in the contracts with managed care organizations.
A scattering of states reported that they do not claim the enhanced xc% federal match for family planning services provided through managed care organizations.
California and New York, states with the most beneficiaries, likewise contract with organized religion-based plans that oppose some forms of contraception. While California reported that they have a process in identify for referral for family planning services for the beneficiaries in these plans, New York did not report a referral practice.

Decision

The assay of state responses to this survey found that overall nigh states cover a wide range of prescription contraceptive methods in their full scope, traditional Medicaid programs and their full telescopic ACA Medicaid expansions, but finds more variation in coverage through the family planning expansion programs. Thirty-half dozen of 41 surveyed states report that they cover all prescription contraceptives for women through their total scope programs. While states are not required to cover all methods nether all pathways, most do. Nonetheless, in that location is more variation between and within states for coverage of over-the-counter contraceptives, including condoms and Plan B emergency contraception pills. In some states that provide coverage, it is only with a prescription which can limit admission to these safe and effective methods. Furthermore, over the years the family planning field has evolved to comprehend other services beyond contraception that help women and men maintain and control their reproductive and sexual wellness. Medicaid coverage for prevention and management of chest and cervical cancers and screening for interpersonal violence is bachelor in most states, but not equally consistently as for contraceptives. These preventive services must be covered by new individual insurance plans equally a result of the ACA, but there is no requirement that they be covered under traditional Medicaid or under the family unit planning expansion programs.

Admission to the full range of contraceptive methods also equally related family planning services has become a standard of comprehensive wellness care for women and men in their reproductive years.² As enrollment in the Medicaid program continues to grow as a result of the ACA and state decisions to expand coverage for family planning services, policy choices defining coverage of services under Medicaid family planning volition continue to be a significant force shaping access to sexual and reproductive health services for depression-income women and men in years to come up.

Acknowledgements

The authors limited appreciation for the help of several individuals who assisted with the preparation, testing, and refinement of the survey instrument, including Yali Bair of Ursa Consulting, Amy Moy from the California Family unit Health Council, Tasmeen Weik of the federal Office of Population Affairs, Melanie Reece of Colorado's Department of Wellness Care Policy and Financing, and Lisa DiLernia of Michigan's Department of Health and Human Services.

Nosotros thank the post-obit colleagues from Health Management Associates: Joan Henneberry for guidance and subject field thing expertise; Dennis Roberts for database evolution and management; and Nicole McMahon for aid with compiling the country information tables.

We also give thanks the Medicaid directors and staff in the 40 states and the Commune of Columbia who completed the survey on which this report is based.