Public funding for family planning client services nationwide reached $1.85 billion in FY 2006, 63% more than the 1994 funding level, in inflation-adjusted terms. However, spending patterns diverged significantly among states, with inflation-adjusted spending for family planning services decreasing or stagnating in one-third of the states between 1994 and 2006, while other states saw substantial increases, according to a new Guttmacher Institute analysis.

“The real story lies in the vastly different family planning funding policies pursued by individual states,” says Adam Sonfield, lead author of the study. “The growth in overall funding at the national level was largely driven by significant spending increases in the 14 states that had implemented Medicaid family planning expansions by the time of our survey. By raising the income level at which clients are eligible to receive subsidized services, these states have made it possible for more low-income individuals to obtain family planning counseling and birth control methods, as well as related medical services such as Pap tests.”

The number of Medicaid family planning clients in the 14 states with family planning expansions grew from 1.8 million to 2.9 million (a 60% increase) between 2000 and 2005. But Sonfield cautions that another major factor behind the spending growth is the rising cost of family planning services and medical care generally: “Family planning providers are struggling with a spike in the price of contraceptive supplies and the need to provide a broader package of services to many medically underserved clients.”

Funding for family planning services suffered major cuts during the early 1980s and has only this decade fully recovered at the national level, in large part because of the increasingly dominant role of Medicaid. Between fiscal years 1980 and 2006, Medicaid emerged as the largest funding source for family planning services; the program’s expenditures rose from 20% to 71% of total funding. During the same period, funding for the federal Title X family planning program did not keep pace with inflation, and its share of total funding fell from 44% to 12%.

“Despite the increasing importance of Medicaid, other funding sources—notably, the Title X program, state appropriations and several federal block grants—continue to play important roles in individual states and, in the case of Title X, nationwide,” says Sonfield. “Together, these programs form a safety net that helps low-income women and couples avoid some 1.3 million unintended pregnancies annually. In their absence, the U.S. abortion rate would be 40% higher than it is.”

About Medicaid family planning expansions

The joint federal-state Medicaid program provides a broad package of medical care, including family planning services and supplies to millions of low-income individuals and families. By FY 2006, 14 states had sought and received a “waiver” of regular Medicaid rules to expand the program’s role in providing contraceptive services. These waiver programs expand a state’s income-eligibility level for family planning well above its level for Medicaid overall.

Six additional states have received approval for similar expansions since 2006, and federal legislation has been proposed to make it easier for every state to follow this path.

Click here for the full report: "Public Funding for Family Planning, Sterilization and Abortion Services, FY 1980-2006."

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Medicaid’s role in family planning

The complementary strengths of Medicaid and Title X

The more than 17 million women in need of publicly funded contraceptive services and supplies