Medicaid Coverage of Family Planning Benefits: Findings from a 2021 State Survey
Family planning services have been part of the Medicaid program for decades. Over time, the field has evolved, with changes in clinical practices and an expansion in the realm of services that address sexual health beyond pregnancy prevention. On the whole, this survey finds that while all states cover a broad range of contraceptive methods, some impose limitations like prior authorization or quantity limits that are sometimes used to help states control spending but can affect beneficiaries’ ability to obtain their preferred contraceptives in a timely manner. Access to newer products, over-the-counter methods, and online services are often less available to those enrolled in Medicaid. We also found less uniformity in coverage policies for recommended non-contraceptive services like expedited partner therapy, to curb the spread of STIs, and PrEP, to prevent HIV infection in higher risk populations.
The survey also illustrates the regulatory complexities that impact coverage for specific services within a state. One of the features of the Medicaid program is flexibility for states to establish coverage policies on their own, within broad federal guidelines. The sheer breadth of family planning products, the different eligibility pathways, the range of utilization controls, varying levels of reimbursement between family planning and related products, and intersection with other public health programs in a state mean that it can be very difficult to ascertain coverage for the range of benefits for the different eligibility pathways available under Medicaid. This survey asked about state policies under fee-for-service, which also form the basis for coverage policies in managed care organizations. For beneficiaries trying to understand and use their Medicaid coverage for important preventive services, particularly if they rely on specific products, it can be formidable to navigate and assess exactly what is and is not covered.
The authors thank the numerous staff members in state Medicaid agencies who participated in the survey. The authors also thank the following individuals, who provided input in the survey questionnaire, data management, and analysis: Jim McEvoy and Kraig Gazley of Health Management Associates; Michael Policar of UCSF; Cathy Peters of the American Cancer Society Cancer Action Network.