Two aspects of recent health reform legislation may help expand access to affordable contraception and family planning services. The first of these is a provision that allows states – through their Medicaid programs – to receive federal funding to cover family planning and related services and supplies for individuals not otherwise eligible for Medicaid.
This coverage would be available to individuals (women and men) who are not currently pregnant and whose income does not exceed an income eligibility level established by the state (similar to special eligibility rules for pregnant women who wouldn’t otherwise quality for Medicaid). Family planning-related services that may be covered include STI diagnosis and treatment, treatment of urinary tract infections, treatment of major complications from family planning procedures such as IUD insertion, and vaccines and other preventive services when provided as part of routine family planning visits.
States will basically have to opt in to this coverage by submitting some paperwork to the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid. States will also set the eligibility guidelines for coverage up to a certain threshold. It is not yet clear how many or which states will be offering this coverage, which will expand access to family planning services for people who earn to much to qualify for Medicaid but who are having difficulty affording this care.
Another provision of the health care reform legislation that will take effect in late September, often referred to as the “Mikulski amendment,” requires that health plans cover preventive care and screenings (at no cost to the individual) for women. The coverage must be based on current evidence-based recommendations of the United States Preventive Services Task Force, and must includevaccines recommended by the CDC, and other care and services “as provided for in comprehensive guidelines supported by the Health Resources and Services Administration [HRSA]for purposes of this paragraph.”
What’s not clear is what guidelines the HRSA will support. Some have suggested that because HRSA doesn’t seem to have its own set of guidelines now, these will need to be created. I think another possible interpretation is that HRSA will identify an existing set of guidelines to support (such as from ACOG or another professional or governmental health organization). Whether new standards have to be created or HRSA simply designates some existing guidelines to support will determine how much room there is to advocate for services, but what will happen is not entirely clear at the moment.
A recent Guttmacher policy review has more on this issue, specifically on whether contraception might be included as preventive care. Guttmacher’s Adam Sonfield has also written about the issue for CNN, concluding:
In short, the case for ensuring family planning services are comprehensively integrated into women’s preventive care and insurance coverage is compelling. More and better contraceptive use will lead to more pregnancies that are planned and wanted, which will lead to more women who are healthy during their pregnancies and whose babies are born healthy. Who could argue with that?
The National Latina Institute for Reproductive Health is planning a “virtual cafecito” to discuss the issue of whether family planning will be included as a preventive service and to discuss strategies for ensuring that Latinas and other women have access birth control options as a preventive service. The call-in discussion will occur Wednesday, July 4 at 1pm EST; register online to participate.