Medicaid an important source of family planning services

States that have expanded Medicaid coverage under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) offer considerable family planning options to low-income women who would otherwise be uninsured. The Kaiser Family Foundation (KFF) noted, however, that about 1.1 million women ages 15-49 do not have health coverage due to lack of Medicaid expansion. The ACA also allows states to more easily provide family planning benefits to those who do not qualify for Medicaid.

Medicaid and family planning

State Medicaid programs are required to offer some sort of family planning benefits, and providers are not permitted to implement cost-sharing. The federal government matches state contributions to participating providers at a 90 percent rate as an incentive for states to expand family planning coverage. States may also receive a higher matching rate for some services related to family planning if they are provided along with family planning.

ACA context

States that expand Medicaid under section 2001 of the ACA must provide preventive services at no cost to the patient pursuant to ACA section 1001, which added section 2713 to the Public Health Service Act (P.L. 78-410). These services include 18 different contraceptive methods approved by the FDA, as well as additional services, such as counseling and screening. However, the KFF notes that there is no federal requirement under traditional, full-scope Medicaid, to provide all approved contraceptives, which means that women covered prior to ACA expansions may have different levels of coverage.

Many states have historically provided family planning services to people who do not qualify for traditional Medicaid benefits through Section 1115 waivers, which allow states to implement program changes when approved by CMS. Section 2303 of the ACA allowed states to establish family planning expansion by creating a state plan amendment (SPA) instead of renewing a waiver every five years. In addition, Medicaid expansion under the ACA provides family planning coverage to low-income women who are not yet parents by eliminating categorical eligibility.

The KFF noted that about 10 million women of childbearing age (15-49) were uninsured in 2014, and just under half qualify for Medicaid or ACA subsidies, or could gain coverage under the ACA in the future. About 1.1 million do not have coverage because their state has not expanded Medicaid, while an estimated 1.9 million additional women forego coverage due to immigration status.