Tuesday, July 16, 2019

Article Index


*112        A. Expanding Access to Gender-Specific Health Care Services Through Medicaid

The Medicaid Family Planning State Option expands on and improves the existing Section 1115 waiver program that at least thirty-one states use to expand access to Medicaid-funded family planning services.  Under existing Medicaid law, states seeking to add new eligibility groups or provide new services under their Medicaid programs can seek a Section 1115 waiver from the Centers for Medicare and Medicaid Services (CMS).  Through this program, the Secretary of Health and Human Services can approve experimental projects that promote the objectives of Medicaid and give states additional flexibility to design and improve their Medicaid programs.  Currently, thirty-one states use a Section 1115 waiver to expand eligibility for Medicaid-funded family planning services: three states provide eligibility to women for two years following a birth funded by Medicaid, two provide family planning services to women losing Medicaid coverage for any reason, and twenty-six states provide family planning benefits to women with eligible incomes, usually below 200% of the federal poverty level.  States have implemented income-based eligibility expansions to provide family planning services to all women who are eligible for Medicaid-funded pregnancy care, achieving substantial savings to state Medicaid programs in the process.  The ACA State Option provision allows states to simply elect, via a State Plan Amendment, to expand eligibility to a new category of non-pregnant women with incomes not exceeding a level set by the state, reducing administrative costs by removing the need to go through the cumbersome Section 1115 waiver process. The provision also gives states choices regarding verifying citizenship of applicants for Medicaid family planning coverage  and allows “presumptive eligibility” for providers to treat apparently-eligible applicants while their applications are being processed by the state, with the assurance that the provider will be compensated for services provided before a final eligibility determination is made. As of September 2013, ten states have approved State Plan Amendments for family planning.

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