WASHINGTON (March 22, 2022)—A major new report from researchers at the George Washington University details findings from the second phase of a landmark study about Medicaid managed care and family planning services. Coming 40 years after Congress enacted special protections to preserve access to family planning services for beneficiaries enrolled in Medicaid managed care, the study found a virtually universal consensus on the enormous value of family planning/managed care integration.
The study also found widespread interest on the part of plans and providers in efforts to improve family planning access and quality using the delivery and payment reform tools of modern Medicaid managed care systems.
“The special family planning access protections enacted in 1981 remain as important today as they were when they became law on a bipartisan basis,” Sara Rosenbaum, the Harold and Jane Hirsh Professor of Health Law and Policy at the GW Milken Institute School of Public Health, said. “At the same time, we have been heartened by the extent to which both plans and providers view family planning as an essential part of Medicaid managed care and have embraced inclusiveness and innovation through delivery and payment reform.”
Rosenbaum is the lead author of the report, which was funded by Arnold Ventures.
The study is the second phase of a nearly two-year project on Medicaid managed care and family planning. The phase two report presents findings from interviews with 10 health plans and 14 providers in 11 states that rely extensively on Medicaid managed care.
Select key findings include:
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In-network status is the norm for both community health centers and family planning-only providers; however, access to out-of-network family planning care remains an extremely important guarantee for Medicaid beneficiaries. Because state policies on the “freedom of choice” provision lack clarity, however, plans and providers report confusion regarding the scope of services covered when furnished by out-of-network providers, thereby limiting the meaning of the protection. Key services raising confusion include sexually transmitted disease treatment, immunizations to prevent cancer, and important types of preventive reproductive counseling such as counseling related to HIV.
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Despite the benefits of the “freedom of choice” safeguard, states, plans and providers all appear to value and pursue family planning integration as a core feature of Medicaid managed care. Given this widespread support, states could encourage a robust approach to family planning provider inclusion as a basic contracting expectation.
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Plans and providers alike express strong interest in pursuing delivery and payment reforms designed to address key family planning access issues such as scope of care or availability of service sites and programs for special populations. Reform strategies could encourage and reward innovations that expand service sites and hours, use of mobile clinics, expanded transportation and translation services, and enhanced follow-up care for certain high-risk patients.
The study makes several key recommendations for strengthening family planning at a critical juncture for health equity. Most importantly, the researchers recommend that federal Medicaid officials quickly revisit a policy released in 2016 that could seriously reduce access to some of the most important family planning services, in particular the treatment of sexually transmitted diseases, HIV assessment and counseling and immunization for the human papillomavirus. All of these are services traditionally furnished in family planning settings and covered under the federal definition of family planning services, the authors said.
The report, “Family Planning and Medicaid Managed Care Integration, Phase 2 Report: Insights from the Field” can be accessed here.
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