Over the past three years, policy changes at the state and federal level in Medicaid and Title X have restricted providers from receiving federal and state funds if they provide abortion services in addition to family planning care. This brief reviews the role of these public programs and providers in financing care and enabling access to family planning services.
It also addresses the impact of actions taken by President Trump and Congress to block federal funds from Planned Parenthood and other entities that provide abortion.
Across the nation, the share of low-income reproductive-age women enrolled in Medicaid varies considerably by state. In , the most recent year in which national enrollment data is available, For these women, Medicaid provides comprehensive affordable coverage to help meet the full range of their health care needs, and guarantees that they will not have any out of pocket costs for family planning services and pregnancy-related care.
Most state Medicaid programs make the full range of FDA approved contraceptives available to women, and nearly all cover counseling on STIs and HIV as well as screening for cervical cancer.
The program funds organizations in each state to distribute federal dollars to safety-net clinics to provide family planning services to low-income, uninsured, and underserved clients.
In June of , approximately 4, clinics nationwide received Title X funding, including specialized family planning clinics such as Planned Parenthood centers, primary care providers such as federally qualified health centers FQHCs , and health departments, school-based, faith-based, and other private nonprofits Appendix Table 2.
Title X grantees must serve low-income populations at low or no cost, and have historically been required to provide clients with a broad range of contraceptive methods as recommended by the national Quality Family Planning Guidelines QFP , and ensure that the services are voluntary and confidential.
In addition to providing clinics with funds to cover the direct costs of family planning services and supplies such as contraceptives, Title X funds enable clinics to pay for patient and community education services about family planning and sexual health issues, as well as infrastructure expenses such as rent, utilities, information technology, and staff salaries.
Title X clinics are also eligible to obtain discounted prescription contraceptives and devices through the federal B program. No other federal program makes funds available to support clinic infrastructure needs specifically for family planning. In contrast, Medicaid reimburses for specific clinical services. The program budget, however, has not kept pace with medical price inflation over time. Clinics that provide family planning services have a mix of revenue sources, including grant funds from Title X and other programs, reimbursement for patients covered by Medicaid or private insurance, and some out of pocket payments from patients.
Over the past decade, the Title X program has experienced significant financial cutbacks due to federal budget reductions and freezes. In addition, some Congressional leaders have questioned the need to continue to fund the program, the types of services that the program can cover and the providers who qualify for funding. In March , the Trump administration published a new regulation that alters the program significantly. In particular, the new rules block the availability of federal funds to family planning providers, such as Planned Parenthood, if they also offer abortion services with non-Title X funds.
The regulation also prohibits Title X-funded providers from making referrals to abortion services for pregnant women seeking that care and requires providers that receive Title X support to refer all pregnant women to prenatal care even if a woman wants to terminate the pregnancy. Currently, the new regulation is in effect, but it has been challenged by 23 states, major family planning organizations, and the American Medical Association in federal court, claiming the new rules violate the Constitution and federal law.
As of October , 18 of 90 grantees that had received funding in April are no longer participating in the program because they are unwilling to comply with the new federal regulations that limit their ability to provide clients with abortion referrals and block them from participating if they also offer abortion services. In addition, one quarter of the family planning approximately 1, clinics network no longer receive Title X funding to support family planning services to low-income women in the community and some states are no longer participating in the Title X program.
The loss of Title X funding may force some clinics to close and others to reduce hours, services, and staff training. Although it is not specifically defined in FQHC guidelines, voluntary family planning services can include preconception care, screening and treatment of STIs, and contraception. A survey of FQHCs found that virtually all reported they provided at least one method of contraception at one or more of their clinical sites.
However, research has documented differences between clinic types in their ability to offer direct access to the most effective contraceptive methods Figure 4.
Similarly, there are differences in capacity for family planning care within the FQHC network. FQHCs are paid using the Prospective Payment System PPS , which is a higher rate to ensure their costs are coverage and clinics are fully reimbursed for Medicaid patient services, allowing them to utilize their federal grant to care for uninsured and under-insured patients.
In the first three years of the Trump Administration, the President and many Congressional Republicans pursued multiple avenues to restrict public funds from going to Planned Parenthood and other clinics that provide both contraception and abortion services. But if the same woman needs to end her pregnancy, Medicaid and other federal insurance programs will not provide coverage for her abortion, even if continuing the pregnancy will harm her health.
The government should not discriminate in this way. It should not use its dollars to intrude on a poor woman's decision whether to carry to term or to terminate her pregnancy and selectively withhold benefits because she seeks to exercise her right of reproductive choice in a manner the government disfavors. With these bans, the federal government turns its back on women who need abortions for their health. Women with cancer, diabetes, or heart conditions, or whose pregnancies otherwise threaten their health, are denied coverage for abortions.
Only if a woman would otherwise die, or if her pregnancy results from rape or incest, is an abortion covered. The bans thus put many women's health in jeopardy. Medicaid offers comprehensive reproductive health care, including family planning, prenatal care, and services related to childbirth. By singling out abortion for exclusion, politicians have attempted to impose their own choices on poor women.
How have women on Medicaid paid for abortions since the Hyde Amendment? Federal funding restrictions have left some women on Medicaid little choice but to use money they need for food, rent, clothing, or other necessities to pay for an abortion. Some even resorted to pawning household goods to come up with the necessary cash. Other women have been forced to carry their pregnancies to term or to seek illegal abortions.
Studies have shown that from 18 to 35 percent of Medicaid-eligible women who want abortions, but who live in states that do not provide funding for abortion, have been forced to carry their pregnancies to term.
Because the costs associated with childbirth, neonatal and pediatric care greatly exceed the costs of abortion, public funding for abortion neither costs the taxpayer money nor drains resources from other services. Our tax dollars fund many programs that individual people oppose. For example, those who oppose war on moral or religious grounds pay taxes that are applied to military programs. The congressional bans on abortion funding impose a particular religious or moral viewpoint on those women who rely on government-funded health care.
Providing funding for abortion does not encourage or compel women to have abortions, but denying funding compels many women to carry their pregnancies to term.
Nondiscriminatory funding would simply place the profoundly personal decision about how to treat a pregnancy back where it belongs -- in the hands of the woman who must live with the consequences of that decision. These women are eligible, however, to receive all other pregnancy-related services. See Hope v. Perales , N. See Alaska v. Planned Parenthood , 28 P. Health Care Cost Containment Sys. Rights v. Myers , P. Maher , A. Wright , No.
Clinic for Women, Inc. Sec'y of Admin. Gomez , N. Ellery , No. BDV Mont. May 22, ; Right to Choose v. Byrne , A. Johnson , P. Dep't of Human Resources , P. Celani , No. SCnC Vt.
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