Major Gains Seen for States that Take Up New Authority to Expand Medicaid Family Planning Services

State-by-State Analysis Projects Significant Improvements in Reproductive Health Outcomes, Major Savings for State Medicaid Programs

A groundbreaking provision included in the March 2010 health care reform law greatly simplifies the process by which a state may expand eligibility for family planning services under its Medicaid program. Using this new authority, individual states could avert thousands of unintended pregnancies, births and abortions, and realize millions of dollars in net savings, according to a new Guttmacher Institute report.

Up to now, Medicaid family planning expansions have been technically considered temporary experiments. The first such "demonstration" programs were approved in the 1990s, and over the years, a large body of evaluation research has shown that they expand low-income women’s access to contraceptive services. By doing so, the programs help more women to avoid pregnancies they do not want and boost maternal and child health by permitting women to better space their births.

"Medicaid family planning expansions are tremendously successful," says Adam Sonfield, the report’s lead author. "That’s why 22 states—including ones as regionally and politically diverse as Texas, California, Pennsylvania and South Carolina—have undergone the cumbersome and time-consuming process that has been required to institute one. Now that the effectiveness of these programs has been demonstrated and the process has been streamlined, other states should follow suit as soon as possible."

The report’s state-by-state analysis includes a table for each state and the District of Columbia, detailing the impact of expanding Medicaid eligibility under the new authority. While the impact would obviously be greatest in the states that currently do not have an expansion in place, even states that already have a temporary program would benefit from using the new authority, because they could cover more women and men than was previously the case.

The impact in the majority of the states would be significant.

  • Among the 28 states that do not have an income-based family planning expansion in place:
  • Among the 22 states that already have a family planning expansion in place:
    • Nineteen states could each serve at least 10,000 more individuals, avert at least 1,500 more unintended pregnancies and save at least $2.3 million more in state funds annually, beyond what they do today under their Medicaid programs.
    • Nine of these 19 states could each serve at least 50,000 more individuals, avert at least 7,500 more unintended pregnancies and save at least $17.4 million more.
    • Eleven could each serve at least 10,000 more individuals, avert at least 1,300 more unintended pregnancies and save at least $1.7 million more in state funds in a single year, beyond what their expansions achieve today.

The report emphasizes that the ultimate impact of an expansion would depend greatly on state-level decisions and factors, including the range of services covered, the quality of care provided and the capacity of the provider network in the state.

"It makes eminent sense for states to make use of this new authority, from both a public health and a fiscal perspective," says Sonfield. "A strong body of research demonstrates the significant impact of these programs in enabling women to avoid unintended pregnancies and the abortions and births that follow. Likewise, the net cost savings should be most welcome at a time when many states face fiscal crises."

Click here for Estimating the Impact of Expanding Medicaid Eligibility for Family Planning Services: 2011 Update, by Adam Sonfield, Jennifer J. Frost and Rachel Benson Gold.

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