As the year draws to a close, women’s health advocates in Pennsylvania are concerned that the governor will allow a family planning program to lapse without ensuring that low-income residents can maintain uninterrupted access to their birth control. An estimated 90,000 women are currently at risk of losing the free reproductive health coverage they get through that special Medicaid program, which is set to expire on December 31.
The program, called SelectPlan for Women, is essentially an experiment in putting Medicaid dollars toward women of reproductive age, hoping that preventing their unplanned pregnancies will ultimately lower health costs. The program offers birth control, emergency contraception, breast exams, Pap smears, and STD treatment at no cost to women whose incomes fall below 214 percent of the federal poverty line.
Since 2007, Pennsylvania has had a special waiver from the federal government to operate SelectPlan. But the waiver expires at the end of this year, and it’s not clear whether Gov. Tom Corbett (R) plans on applying for an extension. According to the Pittsburgh Post-Gazette, women’s health groups in the state have been told to prepare for SelectPlan’s termination.
There are a couple options for the low-income women who may be booted off SelectPlan. If their incomes fall below 138 percent of the federal poverty line, they’ll be able to apply for HealthyPA, which is Corbett’s privatized version of Medicaid expansion. If their incomes are above that, they could get federal tax credits to purchase plans on Obamacare’s new federally-run exchange.
In theory, that could be a good thing, because those plans include broader coverage beyond reproductive health services. But advocates are worried about the fact that losing one type of coverage and being required to fill out the forms for another plan may be too difficult to manage for low-income Pennsylvania residents who already struggle to navigate the insurance industry.
The Affordable Care Act took some important steps to simplify the enrollment process for Medicaid. But the remaining logistical hurdles may still be too much for some stressed out families, according to Sue Frietsche, a senior staff attorney at the Women’s Law Project, a group in Pennsylvania that works to safeguard women’s rights.
“It’s going to be a barrier that a lot of women are just not going to be able to overcome,” Frietsche explained to ThinkProgress. “The forms are complicated and lengthy… It’s a real process and the county assistance offices are not as well staffed as they could be, so documentations is very frequently lost and phone calls are very frequently not returned.”
“People are just going to get lost,” she added.
There’s one easy way to prevent the issues that Frietsche is worried about. If Pennsylvania officials insist on canceling SelectPlan, they could choose to automatically transfer the women who are currently covered in that program over to the new HealthyPA plans. That’s how the health department is handling many of the other categories of people who have been receiving state-funded Medicaid services and who now need to switch over to HealthyPA once it launches on January 1.
But for some reason, the Department of Public Welfare isn’t planning on doing that for the current enrollees in the state’s family planning program. The advocates who spoke with ThinkProgress weren’t sure why.
“I don’t know of any technological barriers or other reasons why they would choose not to do this for SelectPlan,” Amy Hirsch, the managing attorney for the Community Legal Services, a Philadelphia-based organization that provides counsel to low-income residents, said. “We know that the Department of Public Welfare has all the information it would need to just automatically transfer women.”
Faced with the impending deadline of December 31, when thousands of women are set to lose their SelectPlan coverage instead of getting automatically rolled over into HealthyPA, members of the Pennsylvania Women’s Health Caucus recently sent a letter asking the state health department to reconsider its decision to end the program. “Members of the Women’s Health Caucus are deeply troubled by the prospect of health care coverage gaps for low-income women,” the letter reads, noting that Select Plan has helped 119,000 women receive reproductive health services over the past seven years.
Just like implementing an automatic transfer to HealthyPA, applying for a waiver to extend SelectPlan would also be pretty easy. The state simply needs to ask for approval from the federal Center for Medicaid and Medicare Services agency, which has granted similar extensions for other states’ family planning programs.
“It’s very simple. All they need to do is send a letter to CMS and ask them for an extension,” State Sen. Judy Schwank (D), one of the co-chairs of the Women’s Health Caucus, told ThinkProgress. “I’m at a loss to understand why we can’t get this done.”
Frietsche expressed optimism that Schwank’s letter, which was signed by more than 50 lawmakers in the state, may have some influence. But Schwank said she hasn’t received any response so far. The governor’s office did not respond to ThinkProgress’ repeated requests for comment about what exactly is going to happen to SelectPlan.
The upcoming midterm elections may complicate this issue even further. Although Corbett’s Democratic challenger, Tom Wolf, opposes the privatized HealthyPA system, he probably wouldn’t immediately be able to undo it if he’s elected. And while Wolf is currently leading in the polls, he wouldn’t enter the governor’s mansion until after SelectPlan is scheduled to lapse.
If the low-income women in Pennsylvania experience a disruption in their reproductive health coverage this winter, advocates are concerned about the larger implications.
“The consequences of going without family planning services are very obvious — unintended pregnancies, untreated sexually transmitted infections, and undetected cancer,” Frietsche said. “It is absolutely catastrophic.”