Governor agrees to do Jason Rapert's bidding, pursue waivers to stop Medicaid coverage of morning after pill | Arkansas Blog

Governor agrees to do Jason Rapert's bidding, pursue waivers to stop Medicaid coverage of morning after pill

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RAPERT: Trying to stop coverage of morning after pill for very poor women. - BRIAN CHILSON
  • Brian Chilson
  • RAPERT: Trying to stop coverage of morning after pill for very poor women.
Sen. Jason Rapert is on a crusade against emergency contraception, which he says is "killing little babies," against medical evidence. Today, Gov. Asa Hutchinson stated in a letter that he would seek waivers from the federal government to end coverage of the morning after pill in Medicaid, both the private option and traditional Medicaid. That doesn't mean the feds will agree to those requests — more on that below. 

Rapert originally planned to attach an amendment to the Medicaid appropriation on this matter, but he was satisfied with the governor's letter and withdrew the amendment. 

This began last week when Rapert expressed shock that the private option was covering the morning after pill. His surprise was strange because the private option has covered Plan B from the beginning, just as every private health insurance plan in the country is mandated to cover emergency contraception by the Affordable Care Act (there are some very limited exceptions to that requirement, such as for religious institutions). The Obama administration issued a rule last year making it crystal clear that Plan B had to be covered (though typically only with a prescription; an over-the-counter purchase would not be covered). It is a requirement under federal law. Presumably, Rapert's own health insurance plan covers Plan B. 

For that reason, the governor's request to the feds on the private option is going nowhere. The private option covers non-disabled adults who make less than 138 percent of the federal poverty level by using Medicaid funds to purchase private health care plans for low-income Arkansans. Those private plans are regulated by the ACA and must cover the morning after pill (though typically only with a prescription; an over-the-counter purchase would not be covered). Any request by the governor to bar the morning after pill from these plans will be turned down. 

However, states do have some flexibility under Medicaid (as opposed to private plans): while family planning services is a required benefit, states have some discretion over which services are covered. Mississippi does not cover emergency contraception under Medicaid at all (Arkansas has covered Plan B under Medicaid since well before the private option). 

In other words, while the governor's request on the private option is DOA, his request on traditional Medicaid could lead to at least some limitation on access to the morning after pill, or even no coverage for emergency contraception at all. Some of the populations covered by traditional Medicaid are unlikely to need Plan B (the elderly in nursing homes, for example), but some would: Extremely poor parents who make less than 17 percent of the federal poverty level are covered by traditional Medicaid, as are the "medically frail" beneficiaries in the expansion population. 

Note: While legally the Obama administration could grant permission for Arkansas to go the way of Mississippi on no emergency contraception coverage in traditional Medicaid, that doesn't necessarily mean they would

Would the governor's waiver request mean that these folks would not have the morning after pill covered even in the case of rape? I asked the governor's office if there would be a rape exception and have not received a response. 

The federal Hyde amendment, which bans federal spending on abortions, has exceptions for rape, incest, and life of the mother. But the Hyde amendment covers abortion services; it says nothing about emergency contraception. It appears that if a state opted not to cover emergency contraception, it could choose to do so without exception. (Note: in addition to being morally repugnant, this would simply be stupid policy because a rape victim denied coverage for emergency contraception would then be covered by Medicaid for an actual abortion.)

Rapert seems to have been unaware what Arkansas and federal policy was on this matter and this whole kerfuffle has let the cat out of the bag. This issue has nothing to do with "Arkansas Works" — as I mentioned, the state is not going to be able to curtail coverage for the morning after pill on the private option plans, and the issue of how the traditional Medicaid program covers emergency contraception is irrelevant to the Medicaid expansion. 

I want to reiterate that the coverage that Rapert and Hutchinson are seeking to end is prescription only. Beneficiaries must go to a doctor. They are already not covered purchasing the morning after pill over the counter. We are talking about very poor people using this option in emergencies, whether it's situations in which the first means of contraception didn't work or horrific scenarios such as rape. 

As a matter of health care policy, what Rapert and Hutchinson propose is indefensible. 

Support for special health care reporting made possible by the Arkansas Public Policy Panel.


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