For almost 10 years, California and the federal government have agreed to terms on a shared program that allows California to provide family planning services to low-income people who wouldn’t otherwise qualify for Medi-Cal.
Originally started as a demonstration project in 1999, California’s Family Planning, Access, Care and Treatment (F-PACT) program was scheduled to end in 2004 but has lived on in each of the past four years with temporary extensions of the funding arrangement. Now, however, CMS wants to beef up the program’s verification and eligibility requirements.
Family planning advocates say the changes will harm the program, cause Californians to lose coverage and cost the state and federal governments more money in the process.
CMS gave the state until Oct. 3 to comply with the changes or lose funding for the program, which provides service to about 1.65 million Californians annually. People with income below 200% of the poverty level who do not qualify for regular Medi-Cal coverage are eligible for F-PACT services.
California Delegation Weighs In
Thirty-four of California’s 53 members of Congress — all of them Democrats — signed a letter last week urging HHS Secretary MikeÂ LeavittÂ to grant a continuance of the program under its current terms.
Calling for Leavitt to “reconsider your recent Departmental action to impose unworkable new conditions,” the letter says in part:
“As you are aware, the provision of family planning services to this population is designed to prevent unwanted pregnancies. Preventing unwanted pregnancies both reduces births of children who would require Medicaid services and also prevents abortions. Both are highly positive outcomes in themselves and they also have the additional advantage of savings in health care expenditures for both the State and Federal government.”
According to a California Department of Health Care Services fact sheet, the Family PACT program accounts for federal and state savings of nearly $1.5 billion by preventing about 170,000 pregnancies each year.
The letter to Leavitt, signed first by Speaker of the House Nancy Pelosi (D-Calif.), continued:
“Given the success of the program, it is particularly concerning that the Administration has now decided to impose expensive and impractical changes in the procedures for determination of eligibility for the program. The proposed changes will create significant barriers to enrolling women and will require timely and costly procedures that the State cannot meet.”
Statements From CMS, State
Federal and state officials responded to questions with written statements.
Jeff Nelligan, director of media affairs for CMS, wrote:
“CMS is working with California on its family planning demonstration to ensure that the program complies with federal law, particularly with respect to the eligibility determination process.Â This requires, among other things, the collection of social security numbers and verification of citizenship and identity at the time of application, and we need to ensure that California, like all other states, is in compliance with federal law.”
The statement from DHCS is attributed to Norman Williams, deputy director of the Office of Public Affairs:
“Family PACT is an important program that has provided family planning services to more than 1.6 million people, avoiding 170,000 unintended pregnancies a year and resulting in more than $400 million a year in federal savings.Â The state is currently negotiating with the federal government on the terms and conditions of a new Family PACT waiver.Â However, what a new waiver would mean to California is currently unknown so we are unable to answer your questions about what changes are coming to Family PACT, what changes will mean for Family PACT participants, and what the Office of Family Planning is doing about the changes.”
Changes Called ‘Devastating,’ Expensive
Kathy Kneer, president and CEO of Planned Parenthood Affiliates of California, said the changes would be “devastating” and expensive.
Critics of the federal plan say new administrative tasks in the CMS plan would require beneficiaries to file significantly more paperwork and greatly increase bureaucratic procedures. Some say the new provisions could require hiring as many as 2,800 new workers, essentially doubling the number of DHCS staff.
State officials estimate California would lose $262 million in federal funding for budget year 2008-2009 under the new federal rules.
“These changes would be devastating to the women and men we serve every day,” Kneer said.Â “Clients served under the F-PACT program have no other source of medical care and will not get contraception, breast and cervical cancer screening, diagnosis and treatment for STIs (sexually transmitted infections).”
F-PACT advocates estimate CMS changes could increase the per-person cost of the program by more than 65%.
“These changes would cost the state (an additional) $171 to implement per person,” Kneer said. “Right now, the state spends $261 per person for the benefits. It doesn’t make fiscal sense,” Kneer said.
Whenever reproductive rights enter the equation, there’s always the possibility that religious or ideological issues are factors, but in this instance, it appears to be more a bureaucratic turf struggle than an ideological battle.
“CMS is a bureaucracy unto itself,” Kneer said. “They have never much liked our waiver, and I think they think they can get rid of the issue once and for all — regardless if it costs the federal and state government more money.”
Most Medi-Cal providers who deal in reproductive and family planning treatmentÂ — including Planned Parenthood, private-practice physicians, clinics and hospitals — contract with the state through the F-PACT program.
Negotiating, Lobbying Continues
Although CMS’ latest communication referred to the new regulations as “final,” advocates and state officials are pursuing other avenues.
Gov. Arnold Schwarzenegger (R) asked CMS to reconsider the changes and continue negotiating for a long-term solution.
Advocates are hoping for help from elected officials.
“We are trying to obtain a legislative fix that would overrule CMS,” Kneer said.