For states, managed care organizations, and providers—who all play a vital role in ensuring access to family planning services and supplies for the nearly 20 million women ages 18-44 enrolled in Medicaid1—the CIB reiterates existing state and managed care organization requirements and outlines best practices to support robust and equitable access to family planning services and supplies.
Important takeaways for each group:
State Medicaid Programs and Managed Care Plans
- Reiterates baseline federal requirements for family planning coverage and access, including members’ rights to select the provider of their choice (notwithstanding closed managed care networks) and to be free from coercion or mental pressure regarding their choice among contraceptive methods (which limits the range of permissible utilization management practices). These sections build upon similar guidance that CMS issued in 2016.
- Outlines best practices to promote robust access to contraceptives. The CIB covers special considerations for newly available over-the-counter contraceptive drugs, long-acting reversible contraceptives (LARCs), and family planning services in the perinatal period.
- Emphasizes the importance of confidentiality for individuals seeking family planning services. The CIB reiterates applicable federal privacy protections under both Medicaid program rules and HIPAA that prevent state officials and plans from releasing protected data for certain types of law enforcement activities. (For additional discussion of a 2024 HIPAA final rule that specifically protects information concerning reproductive health services, see Manatt’s analysis.)
- Encourages states to assess family planning access and quality. The CIB notes that quality measures for contraceptive care can be used to understand the prevalence of contraceptive care, identify disparities in care, and to develop targeted quality improvement efforts to advance health equity. CMS outlines existing measures in the Child and Adult Core Sets, provides examples and resources about how to leverage other emerging contraceptive measures for quality monitoring and improvement, and notes that states and managed care plans could consider using a broader measure set to assess access to quality family planning services
Family Planning Providers
If family planning providers identify access barriers for their patients, they can remind states and managed care plans of their obligations under federal law. Moreover, they can partner with states and plans to implement best practices and advance innovative family planning models that increase access and quality. For example, the state of Maine is developing an alternative payment model for family planning that aims to support financial sustainability for key safety-net providers and reward providers that implement best practices and deliver high-quality services.
Looking Forward
The CIB aligns with other actions by the Biden Administration to support access to contraceptives and other sexual and reproductive health services and improve maternal morbidity and mortality. Family planning access is critical to addressing maternal health, as research has shown that approximately one-third of maternal deaths could be prevented annually if women who did not wish to become pregnant had access to and used effective contraception. The CIB highlights both existing and new opportunities for states, managed care plans, and family planning providers to enhance coverage of family planning services and supplies, implement strategies to reduce barriers, strengthen confidentiality protections, and utilize quality measures advance health equity.
1 Estimate derived from Centers for Medicare and Medicaid Services 2023 Medicaid and CHIP Beneficiary Profile: Enrollment, Expenditures, Characteristics, Health Status, and Experience (available here)
