CMS Guidance Reminds States About Family Planning Coverage

The Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services has emphatically reminded state Medicaid agencies about their obligations related to Medicaid coverage for family planning services and supplies, and how states should ensure timely access to these services.

CMS issued an informational bulletin last week that detailed requirements for the coverage of family planning services and supplies, strategies to reduce barriers and increase access to contraception, confidentiality protections for those seeking family planning services and supplies, and information on quality measures. It emphasizes that ensuring access to contraception is especially important in the wake of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization.

For example, CMS reminded states and managed care plans that there is a freedom of choice protection for family planning services and supplies in section 1902(a)(23)(B) of the Social Security Act that allows Medicaid managed care enrollees and beneficiaries whose freedom of choice is restricted under other specified authority to obtain family planning services and supplies from out-of-network providers of their choice. This prohibits managed care plans from restricting an enrollee from obtaining family planning services and supplies from a provider of their choosing; moreover, a plan cannot require an enrollee to obtain a referral before choosing a family planning provider. In addition, a managed care plan must ensure that family planning services are provided in a manner that protects and enables the enrollee’s freedom to choose the method of family planning to be used, free from coercion or mental pressure.

The informational bulletin also noted numerous actions states can take to strengthen access to Medicaid- and Children’s Health Insurance Program-covered family planning services and supplies across delivery systems. These are:

• allow for the prescription or provision of six to 12 months of contraception supplies;
• provide timely, patient-centered, comprehensive coverage of contraceptive services (e.g., contraception counseling; insertion, removal, replacement, or reinsertion of long-acting reversible contraception (LARC) or other contraceptive devices) for individuals of reproductive age;
• improve access to over-the-counter (OTC) contraception by issuing statewide protocols or standing prescription orders for an OTC drug, so that pharmacists can issue prescriptions for an OTC drug to Medicaid enrollees directly at the point of sale;
• pay directly for immediate postpartum LARC insertion and unbundle payment for this service from labor and delivery services;
• remove administrative and logistical barriers for supply management of LARC devices (e.g., addressing supply chain, acquisition, inventory, stocking cost and disposal cost issues; allowing for billing office visits and LARC procedures on the same day; removing preauthorization requirements);
• pay for replacement or reinsertion of expelled IUDs, including those placed immediately postpartum, as well as removal upon request;
• include language in managed care contracts that cover family planning services and supplies that reinforces the requirement to cover the full range of covered family planning services and supplies without cost sharing and with freedom of choice of providers; and
• include language in managed care contracts requiring plan networks to include essential community providers for family planning services.

CMS also reminded states that federal Medicaid matching funds at a 90% federal match rate are available for state expenditures attributable to the offering, arranging and furnishing of family planning services and supplies. In addition, states are required to ensure that payments are consistent with “ efficiency, economy and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.”

Family planning services should not be taken lightly. Hopefully, states will heed the details within this bulletin.

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