Editor’s Note: In March 2019, the U.S. Department of Health and Human Services (HHS) issued sweeping new regulations governing Title X funding, a federal grant program that is a major source of financing for family planning services. In a new post for The Commonwealth Fund’s To the Point blog, summarized below, Manatt Health examines how the new HHS regulations—as well as other key developments, including new Medicaid policies—are making it harder for women to access family planning and other preventive health services. Click here to read the full blog post.
Healthy People 2020 cited family planning services as one of the greatest public health achievements of the 20th century and responsible for improving health outcomes for women and their families. However, new HHS regulations over Title X—which provided $286 million to clinics delivering family planning and related healthcare services in 2018—are now putting women’s access to comprehensive healthcare at risk.
The new federal regulations—often referred to as the “gag rule”—impose new restrictions on the information Title X-funded healthcare providers can share with their patients, providing a barrier to comprehensive counseling. The rule also requires Title X grantees that provide abortions using other funds to do so in facilities that are physically and financially separate from the facilities where they are delivering Title X-funded services.
In promulgating the new rule, HHS predicted that the impact on access to services “will be zero.” However, Planned Parenthood—which serves more than 40% of Title X patients—announced late this summer that it will no longer use Title X funding due to the gag rule, and others may follow. A 2017 Guttmacher Institute analysis shows that if Planned Parenthood were to withdraw from the Title X program because of the restrictions, other providers could not fill the gap. Even if in some communities could absorb the increase in volume, low-income women with limited transportation options could not necessarily get to them.
Medicaid and Related CMS Developments Further Jeopardize Access
Funding for family planning is also affected by Medicaid policy. Medicaid is the largest source of public funding for family planning services. Federal Medicaid law guarantees access to family planning services through the Medicaid benefit plan and provides protections to women seeking family planning services.
Some states, however, are attempting to exclude clinics and other providers who perform abortions from participating in Medicaid-funded family planning services. The Centers for Medicare & Medicaid Services (CMS) has paved the way for this policy, having rescinded 2016 guidance that clarified these types of restrictions were prohibited by federal Medicaid law. CMS is currently reviewing waiver proposals from Texas and Tennessee that would allow them to receive federal Medicaid funding, even if they impose restrictions tied to whether providers offer abortion services using other funds. If approved, the waivers will likely be challenged in court—but the courts will no longer have the benefit of CMS’s now-rescinded guidance when reviewing applicable law.
Earlier efforts in Texas to limit family planning shed light on the likely impact of these waivers. In 2011, CMS denied federal funding to Texas after the state excluded clinics that provide abortion services from participating in its Medicaid-funded family planning waiver program. As a result, claims for long-acting, reversible contraceptives decreased by 36% between 2011 and 2014; the rate of Medicaid-covered childbirth increased by 27%; and, even with new state investment, access plummeted by tens of thousands compared to 2010.
Conclusion
Family planning policies continue to evolve at the federal and state levels, with the courts increasingly engaged. Low-income women’s access to these services which may be their principal access point for care, hangs in the balance.