Kaiser Family Foundation Releases Two Reports on Access to Family Planning and Prenatal Services for Medicaid Beneficiaries

The Kaiser Family Foundation recently released two reports examining how Medicaid coverage for reproductive health services has changed in response to managed care, the rise of faith-based health plans and family planning waivers. The first study examines Medicaid coverage for family planning services and the second report looks at Medicaid coverage of prenatal care (KFF release, 10/16).

Medicaid and Family Planning
Although Medicaid managed care plans may expand beneficiaries' access to providers and gynecologists, they may also have caused confusion regarding where enrollees can access care, the report states. Health Systems Research interviewed state public health officials who oversee the distribution of federal family planning funds, as well as representatives of clinic associations or major providers of family planning services to low-income individuals in each state. The report concluded that although the Medicaid programs cover a wide range of family planning services, state Medicaid programs vary substantially in the specific services they cover and the information provided to enrollees regarding these services. In addition, those in Medicaid managed care plans may not know of their right to visit out-of-plan providers, an issue that is "particularly important to women who are enrolled in faith-based plans or using faith-based providers" ("Medicaid Coverage of Family Planning Services: Results of a National Survey," November 2001).

Medicaid and Prenatal Care
Medicaid funds approximately one-third of all births in the United States. Women who receive Medicaid-funded maternity services typically fall into two categories -- Medicaid beneficiaries who become pregnant while enrolled in Medicaid and women who qualify for Medicaid under pregnancy-related expansion categories with higher income limits. However, the report states that the rise of Medicaid managed care programs has "considerably" changed the face of Medicaid. More than 50% of all Medicaid beneficiaries are currently enrolled in a Medicaid managed care plan. From August 1999 to March 2000, Health Systems Research interviewed Medicaid officials from 47 states and the District of Columbia. Interviews were also conducted with 14 representatives from the American College of Obstetricians and Gynecologists. The report concluded that even if states include certain pregnancy-related services in their Medicaid plans, those services may not be accessible to beneficiaries. Many state officials say that the advent of Medicaid managed care plans has helped increase the number of providers who will treat Medicaid beneficiaries, but other states still report problems retaining providers in the Medicaid network ("Medicaid Coverage of Perinatal Services: Results of a National Survey," November 2001).