July | August 2017




Medicaid and Planned Parenthood

By Debra Miller, CSG Director of Health Policy
Indiana’s bid to cut off funding for Planned Parenthood could invoke a “nuclear option” leading to a loss of $6.3 billion in federal Medicaid funds, the state Solicitor General Thomas Fisher said.
He told federal district court Judge Tanya Walton Pratt that makes him nervous, The Associated Press reported.
At issue is a new state law that prohibits any payment for Medicaid family planning services to Planned Parenthood service providers. Indiana Planned Parenthood is seeking an injunction of the new law.
Sen. Scott Schneider, who sponsored the bill, seems satisfied the law will stand.
“The case made by Planned Parenthood is nothing more than a false alarm and their claims that women will go without health services are false,” he said in a statement in May after Pratt refused to issue a summary injunction. “They would have everyone believe they are the only provider of women’s health services in Indiana, but there are 150 clinics throughout the state that can still provide Hoosier women with the services they need. Our new law will allow Planned Parenthood to continue to receive taxpayer funding if they simply stop performing abortions. The decision is theirs to make.”
But Planned Parenthood disagrees. “At a time when women need more health care, they should expand access to health care not restrict access,” said Tait Sye, a spokesman for Planned Parenthood. “The new law cuts off access to 10,000 women to preventive health care at Planned Parenthood, the provider of their choice.”
Indiana is the first state to prohibit Medicaid payments to Planned Parenthood. Federal law already prohibits Medicaid funding of abortions, except in cases of rape, incest or endangerment of mother’s life.
In a June 1 letter, federal Medicaid administrator Dr. Donald Berwick notified Indiana that its state plan amendment to implement the prohibition was not approved.
“We assume this decision is not unexpected,” Berwick said in the letter. “As the Indiana Legislative Services Agency indicated in its April 19, 2011, fiscal impact statement, ‘While States are permitted to waive a recipient's freedom of choice of a provider to implement managed care, restricting freedom of choice with respect to providers of family planning services is prohibited.’”
The state has 60 days from June 1 to appeal the federal decision.
The Medicaid changes eventually could end up in a federal court under a prescribed appeals process, Fisher told Pratt. And, he conceded, the federal government could in the meantime discontinue federal funding for Indiana’s Medicaid program.
The Department for Health and Human Services served states notice in a June 1 bulletin that “Medicaid programs may not exclude qualified health care providers—whether an individual provider, a physician group, an outpatient clinic, or a hospital—from providing services under the program because they separately provide abortion services (not funded by federal Medicaid dollars, consistent with the federal prohibition) as part of their scope of practice.”
Other states are exploring alternative avenues to discontinue public funding of any Planned Parenthood services. Kansas Gov. Sam Brownback included in his proposed budget reallocating $334,000 in the Title X family planning program from Planned Parenthood to state and local health clinics. The Wichita Eagle reported the money had paid for family-planning services for low-income women in clinics in Wichita and Hays. Services included contraception, pap smears and cancer screenings. The provision remained in the budget bill Brownback signed in late May and will take effect July 1. Sye, of Planned Parenthood, said the organization is reviewing their legal options in Kansas.
“Our position is that the pots of money may be different in Kansas than Indiana, but the same federal principle applies,” he said.
A provision to defund Planned Parenthood was included in the Tennessee state budget adopted by the legislature and signed by the governor, but a separate provision appears to nullify it. In Texas, the legislature considered but did not adopt a similar reallocation of family planning funds away from Planned Parenthood. Now that Gov. Rick Perry has called a special session to resolve some last-minute budget issues, some are urging him to include the issue in the special session. While it is not clear is the issue will be taken up, Lucy Nashed, a spokeswoman for Gov. Perry, told the Houston Chronicle the recent federal bulletin is "another example of the federal government's overreach into how the states deliver health care to their citizens."
In North Carolina, theNews and Observer in Raleigh reports the House inserted one sentence in its budget singling out Planned Parenthood and barring the state from making any grants or entering into any contracts of any kind with the organization. The budget has been approved by the Senate and is now awaiting Gov. Beverly Perdue’s signature.
The Milwaukie Journal Sentinel reports that a budget provision is moving to prevent any family planning funding of nine Planned Parenthood clinics. Even though the funds in the proposal are state only funds, the change would require federal approval.
Finally in Oklahoma, legislators considered but let die in committee, a provision to prohibit Planned Parenthood clinics from distributing vouchers and providing nutrition services under the Women, Infants and Children nutrition program.


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