WASHINGTON (June 17, 2021)—A new report by researchers at the George Washington University lays out a blueprint for policies that can strengthen family planning for millions of Medicaid beneficiaries enrolled in Medicaid managed care. The report presents a first-of-its kind nationwide study, undertaken 40 years after passage of federal legislation known as the freedom of choice safeguard. Its purpose is to ensure that Medicaid managed care plan members retain access to high-quality, comprehensive family planning services from any qualified Medicaid family planning provider, regardless of limits on plan coverage or provider networks. The law also helps ensure that religiously-affiliated health plans can participate in Medicaid managed care even if they choose to offer limited family planning coverage and care.
Since the freedom of choice safeguard was enacted, no systematic study has ever examined how states have implemented this special rule as part of their managed care systems or whether Medicaid family planning simply has remained a separate fee-for-service benefit outside the scope of managed care contracts. Understanding the relationship between Medicaid managed care and family planning has emerged as a major policy matter given the size of the Medicaid managed care population (70 percent of all beneficiaries), the importance of family planning to the health of women, children, and families, and states’ growing emphasis on robust plans that can address a full range of health needs.
“Our study shows that all states using comprehensive managed care have embraced family planning as a core element of their governing contracts, which set forth coverage, care, and operational requirements. These documents provide crucial evidence that states consider family planning as basic to their managed care systems and thus key to “whole-person” health,” said Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law and Policy at the GW Milken Institute School of Public Health, and principal study author.
Public health experts recognize family planning as one of the nation’s most important public health achievements. Family planning has been a mandatory Medicaid benefit since 1972, and the scope of family planning services was significantly expanded under the Affordable Care Act. Experts point to voluntary, patient-centered family planning as a core element of any strategy to improve maternal, infant, and child health, major priorities for the Biden administration and state Medicaid programs nationally.
The report comes at a critical time in national family planning policy, noted Rosenbaum, as the Biden administration is seeking to strengthen family planning services including the Title X Family Planning Program, whose nationwide provider network plays an essential role in serving Medicaid beneficiaries. This network, she noted, is a natural starting point for managed care systems seeking to ensure access to care.
The new report’s findings and recommendations contain important suggestions for how Medicaid might enhance this overall effort to improve the accessibility and quality of family planning services.
Key Findings and Recommendations
- All states that purchase comprehensive Medicaid managed care (39 states and the District of Columbia) make family planning an essential element of their contracts and care purchasing strategies.
- At the same time, many contracts remain unclear regarding the scope of family planning coverage, provider networks and accessibility, and the extent to which plans are responsible for educating members about their right to care. Contracts also contain limited provisions regarding performance measurement or mechanisms for ensuring that family planning is part of whole-person care.
- Federal law gives states important options for improving family planning access, comprehensiveness, and integration into managed care systems. One key area of focus is to update the scope of family planning services covered by the freedom-of-choice safeguard, especially in light of the Affordable Care Act’s expanded definition of family planning services. Of special importance is expanding the definition of core family planning services to include sexually transmitted infection diagnosis and treatment, HIV assessment, and HPV immunizations. Another important issue is developing strategies for building and sustaining strong, patient-centered, and accessible provider networks to ensure not only that comprehensive family planning needs are met but that patients receive follow-up care for other physical and mental conditions that could affect health.
- The Centers for Medicare & Medicaid Services (CMS) can do much to encourage and promote the integration of high quality family planning into managed care by modernizing and updating longstanding guidance and ensuring that patients are fully informed regarding the freedom of choice safeguard. Also important is guidance on approaches to effective family planning integration, strategies for reaching special need populations, and developing performance measures and quality improvement using landmark quality standards published by the U.S. Department of Health and Human Services in 2013. Finally, CMS could advance these goals by developing and encouraging value-based payment approaches as a means of encouraging high performing plans and provider networks.
The report, “Family Planning and Medicaid Managed Care: Improving Access and Quality through Integration,” was produced by Rosenbaum and a team of researchers at the GW Milken Institute School of Public Health in collaboration with Health Management Associates.
The project was supported by Arnold Ventures, a philanthropy dedicated to tackling some of the most pressing problems in the United States.
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