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Expanding Medicaid income eligibility for family planning: an opportunity to improve reproductive outcomes and lower Medicaid costs.

The State of North Carolina is requesting federal approval from the Centers for Medicare and Medicaid Services (CMS) to extend eligibility for family planning services to all women and men from 19 to 55 years of age with incomes at or below 185% of the federal poverty level. Unlike the Medicaid expansions for pregnancy-related care, which are specifically provided for in the federal statute, a family planning expansion must be approved by CMS as a Medicaid Family Planning 1115 Demonstration. To be approved, the proposal must be budget neutral—the added Medicaid family planning costs must be offset by at least a similar decrease in maternity and infant healthcare costs. As with maternity care, services may be offered by both public and private providers. Current Medicaid regulations provide coverage to pregnant women and to infants (younger than a year) at or below 185% poverty. However, these women are eligible for Medicaid benefits only during the period following the confirmation of their pregnancy through 60 days postpartum. After 60 days postpartum, women who no longer meet the state’s more stringent financial criteria for participation in the Medicaid program lose eligibility for all benefits, including family planning. It has been estimated that more than two-thirds of the approximately 45,000 women eligible for Medicaid each year due to pregnancy lose their Medicaid coverage after 60 days postpartum, leaving them without family planning or preventive health services coverage. Among all North Carolina women of childbearing age, there are estimates that more than 318,000 women aged 20-44 are in need of publicly supported contraceptive services and do not have Medicaid coverage for these reproductive health services. 1 Although the 170 publicly supported family planning clinics in North Carolina serve 125,500 women aged 20-44, this represents only 39% of all women in need. Publicly supported contraceptive services are provided to 179,340 low-income women of all ages each year in North Carolina, and these women avert over 41,000 pregnancies each year. 2