F ACT SHEET
Why the Affordable Care Act Matters for
Women: Expanding Medicaid Family
Planning Services
OCTOBER 2015
Publicly funded family planning services provide essential health care that low-income
women urgently need. For many women, the cost of contraceptive services is a significant
barrier to accessing this important care. In addition, barriers to access have been shown to
create disparities in contraceptive use – disparities that are later reflected in rates of
unintended pregnancy.
Affordable Family Planning Through Expanded Medicaid
Eligibility
Thirty states and the District of Columbia1 have expanded their Medicaid programs to
include individuals with incomes below 138 percent of the federal poverty level (FPL).2
This means that many more women now have access to comprehensive coverage and health
care services, including no-cost family planning care and supplies.
The ACA allows states to expand eligibility for Medicaid-covered family planning services
without having to go through the cumbersome federal waiver process previously
required.
 Under the federal waiver system, it took an average of 20 months to approve a state
proposal to expand eligibility. Moreover, waivers had to be renewed after five years
and then again every three years after that. Under the ACA, states are now able to
expand eligibility for Medicaid-covered family planning care through a State Plan
Amendment (SPA), which is a faster, streamlined, permanent process.
 In addition to covering family planning care for more women, most states provide
Medicaid coverage to pregnant women with incomes at or above 200 percent FPL (a
more generous income cap than what is typically used to determine Medicaid
eligibility).3 The ACA allows states to use their pregnancy-eligibility income threshold
to determine eligibility for Medicaid-covered family planning services. As a result,
many more women now have access to affordable family planning care.
1875 Connecticut Avenue, NW | Suite 650 | Washington, DC 20009
202.986.2600 | www.NationalPartnership.org
 Studies have found that increasing
Expanding Medicaid eligibility
eligibility not only expands access to care
means savings for both the
but also improves the geographic
federal and state governments.
availability of reproductive health
services, increases the diversity of
providers and reduces unintended
pregnancy. Furthermore, expanded eligibility generates significant savings for both
the federal and state governments.4
 As of August 2015, 28 states have received federal approval to expand eligibility for
Medicaid family planning services through an SPA or waiver. Fourteen states operate
their programs through SPAs and 14 states continue to offer expanded coverage
through a waiver from the federal government.5
1 Families USA. (2015 July). A 50-State Look at Medicaid Expansion. Retrieved 21 August 2015, from http://familiesusa.org/product/50-state-look-medicaid-expansion
2 Note: Prior to ACA implementation, eligibility levels varied widely, with most states providing a relatively high eligibility level for children, but with a broad range of eligibility
requirements for adult parents and generally no coverage for adults without minor children.
3 The Henry J. Kaiser Family Foundation. (2015 April). Where Are States Today? Medicaid and CHIP Eligibility Levels for Adults, Children, and Pregnant Women. Retrieved 21 August
2015, from http://kff.org/medicaid/fact-sheet/where-are-states-today-medicaid-and-chip/
4 Frost, J.J., Finer, L., & Tapales, A. (2008). The Impact of Publicly Funded Family Planning Clinic Services on Unintended Pregnancies and Government Cost Savings. Journal of
Health Care for the Poor and Underserved, 19, 778-796. Retrieved 21 August 2015 from, https://www.guttmacher.org/pubs/09_HPU19.3Frost.pdf
5 Guttmacher Institute. (2015 August). State Policies in Brief: Medicaid Family Planning Eligibility Expansions. Retrieved 21 August 2015, from
http://www.guttmacher.org/statecenter/spibs/spib_SMFPE.pdf
The National Partnership for Women & Families is a nonprofit, nonpartisan advocacy group dedicated to promoting fairness in the workplace, access to quality health care and
policies that help women and men meet the dual demands of work and family. More information is available at www.NationalPartnership.org.
© 2015 National Partnership for Women & Families. All rights reserved.
NATIONAL PARTNERSHIP FOR WOMEN & FAMILIES | FACT SHEET | EXPANDING MEDICAID FAMILY PLANNING SERVICES
2