The Impact of Medicaid and Title X on Planned Parenthood

Medicaid and Title X, the federally funded family planning program, reimburse or fund Planned Parenthood clinics to provide contraceptive care, STI testing, pregnancy testing, and gynecological services to low-income and uninsured individuals. Over the past decade, policy makers who oppose abortion have attempted to block Planned Parenthood sites from obtaining state or federal funds largely due to their provision of abortion services. However, federal Medicaid dollars can only be used to pay for abortions under Hyde exceptions: rape, incest, and life endangerment and the Title X statute specifies that no federal funds appropriated under the program “shall be used in programs where abortion is a method of family planning.” A loss of Medicaid and Title X funding will likely mean that affected Planned Parenthood clinics will have fewer resources to serve low-income clients, could have longer wait times for those who seek care, and low-income patients could face limits to contraceptive access and STI screening. Ultimately, some of the clinics may be forced to close with impacts in many communities across the county.

Planned Parenthood and Medicaid

The Supreme Court of the United States is currently considering a case, Medina v. Planned Parenthood South Atlantic, that could ultimately have implications on whether states can disqualify Planned Parenthood clinics from their network of Medicaid participating providers. This would directly impact Medicaid beneficiaries who rely on Planned Parenthood for a broad range of sexual and reproductive health services. Based on claims from the 2021 Transformed Medicaid Statistical Information System (T-MSIS) data, one in ten (11%) reproductive age women covered by Medicaid who received family planning services got their care at a Planned Parenthood clinic (Figure 1). All state Medicaid programs are required to cover family planning services, which include contraception, STI services, Pap smears, and pelvic and breast exams free of cost-sharing to all their beneficiaries. The share of Medicaid beneficiaries using family planning services who rely on Planned Parenthood ranges from three in ten women with Medicaid in California (29%), to no women in in North Dakota and Wyoming where Planned Parenthood does not have a presence. Texas officially excluded Planned Parenthood from the state’s Medicaid program on March 10, 2021, so a limited number of claims were identified.

While Planned Parenthood clinics have been targeted because many provide abortion services, the majority of people go to Planned Parenthood clinics for contraceptive services, STI testing, pregnancy testing, and gynecological services. Nearly nine in ten female Medicaid beneficiaries ages 15 to 49 who got family planning care at a Planned Parenthood clinic in 2021 received contraceptive services and over half received STI services (Figure 2). Nearly half also got gynecological services like a Pap smear, HPV screening, or a pregnancy test.

Planned Parenthood and Title X

The Title X program supports a network of approximately 4,000 clinics across the country to offer free or reduced cost family planning services to low-income and uninsured people. Nationally, 281 Planned Parenthood clinics in 35 states and DC, half (51%) of Planned Parenthood clinics nationwide, participate in the Title X program (Figure 3). Planned Parenthood grantees applied for and qualified to receive a total of $20.6 million to provide services to low-income and uninsured women and men, accounting for 8% of the total $261 million awarded nationally for Title X funding. Other Title X grantees also include Planned Parenthood sites in their network of clinics.

Figure 3

On the same day that oral arguments were heard for Medina v. Planned Parenthood South Atlantic, the US Department of Health and Human Services (HHS) announced that they were withholding Title X awards from 16 of the 86 Title X grantees across the country, which include all of the Planned Parenthood grantees. Additionally, the funding freeze impacted other organizations that include Planned Parenthood sites in their networks of clinics. While the funding freezes do not impact all Planned Parenthood clinics, overall, 130 Planned Parenthood clinics in 21 states are directly affected by the freeze.

Figure 4

Methods

Data: This analysis used the 2021 Release 1 T-MSIS Research Identifiable Files, specifically the other services (OT) claims files merged with the demographic-eligibility (DE) files, limiting to females ages 15 to 49. Identifying Planned Parenthood Providers: To identify family planning services provided at a Planned Parenthood clinic the NPPES NPI Registry was used to search for Planned Parenthood and PPFA in the Organization Name field to create a list of Planned Parenthood organization NPIs. Identifying Family Planning Services: Diagnosis and procedure codes in the other services header and line claims files were used to identify the following family planning services: contraceptive services, STI services, gynecological services including Pap smear and HPV testing, as well as pregnancy testing. A family planning diagnosis was required for inclusion. A list of diagnosis and procedure codes is available upon request. State exclusion criteria: GA, IL, and MS were excluded due to data quality concerns. These states had unusable data in the following categories according to the DQATLAS: GA’s Billing Provider NPI data and MS’s Service Users – OT. There were no Planned Parenthood providers identified in IL despite their extensive network of Planned Parenthood clinics, which leads us to believe there is an issue with the Billing Provider NPI.