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State Medicaid Programs and Pregnancy Prevention

What if our government had the power to prevent hundreds of thousands of unintended pregnancies and abortions every year — and, in the process, could save millions of dollars in annual spending? While such a scenario may sound too good to be true, these outcomes are easily within reach if federal and state governments expand Medicaid coverage for contraception.

Every state Medicaid program currently covers pregnancy care for low-income women (those with incomes below 133 percent of the federal poverty level — just under $30,000 for a family of four). In fact, Medicaid pays for 41 percent of all births in the United States. But in many states, low-income women seeking to plan their pregnancies may be unable to access contraceptives and other family planning services.

  • The Guttmacher Institute estimates that a low-income woman in the United States, compared to her higher-income counterpart, is 
    • nearly four times as likely to have an unintended pregnancy 
    • five times as likely to have an unintended birth 
    • more than three times as likely to have an abortion
  • Four in 10 low-income women of reproductive age have no insurance; more than six in 10 are not covered by Medicaid.
  • Establishing equality between pregnancy coverage and family planning coverage would not only expand access to contraceptives, but it would also increase access to basic preventive health care for women. Breast and cervical cancer screening, blood pressure testing, pelvic exams, and screening for sexually transmitted infections, including HIV, are all covered services under a Medicaid women’s health care visit. In addition, these basic health care visits often serve as the entry point into the health care system for millions of women. Among women patients below the federal poverty level, seven in 10 consider a women’s community health provider, like Planned Parenthood, their primary source of health care.
  • During these difficult economic times, states are being forced to cut their women’s health care programs just as more families need access to quality, affordable health care. In fact, more than 17 million women need publicly funded reproductive health care, and with more women losing their health insurance along with their jobs, this number will likely continue to increase.
  • Women are the primary health care decision makers in most families, and their own health care is often the first to be dropped. More than half of women report cost-based difficulties in accessing health care, and one-third of women report not filling a prescription because of cost.

SUCCESSES

  • Many states have already increased access to family planning services under Medicaid, though they’ve done so with great difficulty. Since the early 1990s, 27 states have expanded Medicaid family planning coverage to women and sometimes men who would not otherwise be eligible for Medicaid services. In order to implement these expansions, states must currently obtain special permission from the federal government, and this process can be cumbersome and expensive for states.  
  • States that have expanded coverage of family planning services under Medicaid have seen excellent outcomes — both in expanded access to services and reduced costs.  
    • In 2005–2006, California’s family planning program (the nation’s largest) helped women avoid 248,000 unintended pregnancies.
    • Every dollar spent on reproductive health care saves $7 in Medicaid-related costs alone.

Planned Parenthood supports federal legislation that would create a state option for Medicaid family planning coverage. This small but important change in federal law would give states the flexibility to expand family planning coverage without having to navigate the burdensome approval process currently in place. We support a state option to expand coverage for family planning services up to the income level at which pregnancy-related care is covered under Medicaid. This would make it much easier for states to adopt these proven-effective expansions of coverage.

It is critical that Congress act quickly to pass this commonsense legislation and improve states’ ability to meet the basic health care needs of women and their families.