Restricting Women’s Choice of Provider in Medicaid Violates Intent of the Program, Undermines Access to Critical Health Care
Washington, D.C. – Senate Finance Committee Ranking Member Ron Wyden, D-Ore. and Ranking Member of the Senate Health, Education, Labor, and Pensions (HELP) Committee Patty Murray, D-Wash., along with 37 Senate Democrats, today urged the Trump Administration to reverse its decision to rollback protections that prevent states from excluding qualified women’s health care providers from the Medicaid program. The letter to Health and Human Services (HHS) Secretary Alex Azar, comes after recent reports that in rescinding the guidance, the Administration worked with conservative outside groups to make it easier for states to defund providers such as Planned Parenthood.
“This most recent decision is another step in [the Trump Administration’s] ideological and discriminatory agenda, as it encourages states to block Planned Parenthood and other essential providers from participating in state Medicaid programs,” the senators wrote. “Continuing this agenda of discrimination by promoting the state-by-state repeal of the free choice of provider provision and defunding of qualified family planning providers like Planned Parenthood is unacceptable, unlawful, and threatens the lives and rights of millions of women across the country.”
The letter, sent to Health and Human Services (HHS) Secretary Alex Azar, makes clear the consequences this decision will have on a woman’s ability to see the doctor of her choice. It also signals the decision violates the longstanding protections and objectives of the Medicaid Act. The rescinded guidance was originally issued in April 2016 by the Centers for Medicare & Medicaid Services (CMS), reaffirming the free choice of provider right and stating clearly that the Medicaid Act prohibits states from targeting providers for reasons unrelated to their fitness to perform or bill for covered medical services.
Joining Wyden and Murray on the letter are: Sens. Richard Blumenthal, D-Conn.; Sherrod Brown, D-Ohio; Bernie Sanders, I-Vt.; Kirsten Gillibrand, D-N.Y.; Tammy Baldwin, D-Wis.; Elizabeth Warren, D-Mass.; Maggie Hassan, D-N.H.; Corey Booker, D-N.J.; Dick Durbin, D-Ill.; Sheldon Whitehouse, D-R.I.; Edward J. Markey, D-Mass.; Tina Smith, D-Minn.; Jeanne Shaheen, D-N.H.; Mazie K. Hirono, D-Hawaii; Angus King, I-Maine; Jon Tester, D-Mont.; Michael Bennet, D-Colo.; Dianne Feinstein, D-Calif.; Catherine Cortez Masto, D-Nev.; Brian Schatz, D-Hawaii; Tammy Duckworth, D-Ill.; Tim Kaine, D-Va.; Patrick Leahy, D-Vt.; Maria Cantwell, D-Wash.; Jack Reed, D-R.I.; Debbie Stabenow, D-Mich.; Tom Carper, D-Del.; Chris Van Hollen, D-Md.; Chris Murphy, D-Conn.; Chris Coons, D-Del.; Kamala Harris, D-Calif.; Bob Menendez, D-N.J.; Gary Peter, D-Mich.; Bill Nelson, D-Fla.; Amy Klobuchar, D-Minn.; Jeff Merkley, D-Ore.; and Ben Cardin, D-Md.
The full letter can be found here and below.
The Honorable Alex Azar
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
Dear Secretary Azar:
We write to express our deep concern regarding the Department of Health and Human Services’ decision to rescind 2016 guidance regarding women’s right to receive care under Medicaid from the qualified family planning provider of their choice. Since day one, this Administration has taken direct aim at women’s health by obstructing access to services critical for women’s health, financial security, and equality, including contraceptive care. This most recent decision is another step in this ideological and discriminatory agenda, as it encourages states to block Planned Parenthood and other essential providers from participating in state Medicaid programs. Excluding these qualified providers would have devastating consequences for millions of women who need access to affordable family planning services and would violate Congress’s longstanding intent to protect beneficiaries’ right to see the family planning providers they trust.
Medicaid is the primary provider of family planning services in the United States, covering one of every five women of reproductive age and 75 percent of all publicly funded contraceptive services. Medicaid has provided women with the unequivocal right to seek family planning services from the providers of their choice for decades. Yet, despite such clear protections, numerous states have attempted to use the Medicaid program to target providers of legal abortion services, including Planned Parenthood. In response to these state efforts, the Centers for Medicare & Medicaid Services released guidance in April 2016 to reaffirm the free choice of provider right, stating clearly that the Medicaid Act prohibits states from targeting providers for reasons unrelated to their fitness to perform or bill for covered medical services. This guidance reinforced the requirement and the principle that states should use evidence-based standards, not ideological agendas, to determine who should be able to provide care to their communities.
On January 22nd, the Administration rescinded this guidance, signaling its intent to allow states to exclude qualified providers from their Medicaid programs. These exclusions target health care providers for reasons wholly unrelated to the fitness of the provider and their ability to provide professional care in a competent, safe, and legal manner. Accordingly, approving such proposals would elevate an ideological agenda above the needs of Medicaid beneficiaries and the rights and protections guaranteed to them under federal law.
Excluding qualified family planning providers from the Medicaid program would have far-ranging and dire consequences for women’s health. Many beneficiaries rely on family planning health centers as their only source of essential primary and reproductive health services, including contraception, testing for HIV and sexually transmitted infections, screenings for cervical and breast cancer, and vaccines. By withholding Medicaid funds from trusted family planning providers like Planned Parenthood, states would undermine access to these services, inevitably leaving women with higher rates of unintended pregnancy, cancer, and maternal mortality. These effects would be disproportionately borne by women of color and women in rural communities, widening our nation’s health disparities.
Allowing states to exclude qualified providers from state Medicaid programs would also plainly violate the longstanding protections and objectives of the Medicaid Act. While the Medicaid Act grants states the flexibility to waive certain federal requirements, Congress has made it clear that states must promote, not restrict, access to health care in order to obtain waivers under the program. Further, when Congress amended the Medicaid Act in 1967 to include the free choice of provider provision, it did so in response to state efforts to restrict beneficiaries’ access to care, including efforts to exclude providers from the program. This amendment plainly reflected Congress’s intent to expand, not limit, Medicaid beneficiaries’ ability to make health care decisions free of a state’s ideological interference. As a result, since these protections have been in place, a state has never been permitted to bar a qualified family planning provider from Medicaid because of the legal services that provider offered.
Reproductive health care is essential for all Americans and in particular for women’s health, economic security, and equality. Yet, this Administration has undertaken a campaign to obstruct access to these services by allowing employers to deny birth control coverage to their employees, gutting evidence-based teen pregnancy prevention programs, jeopardizing the lives of women abroad through reinstating and expanding the Global Gag Rule, censoring language related to abortion and health care for LGBTQ individuals, allowing providers’ personal beliefs to dictate how and whether someone should be treated, and supporting legislation to prevent Planned Parenthood from participating in the Medicaid program nationwide. Continuing this agenda of discrimination by promoting the state-by-state repeal of the free choice of provider provision and defunding of qualified family planning providers like Planned Parenthood is unacceptable, unlawful, and threatens the lives and rights of millions of women across the country. For these reasons, we urge you to reconsider your decision to rescind the 2016 guidance and reject state proposals that would undermine access to qualified family planning providers in Medicaid.