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Missouri budget cuts family planning funds for uninsured women, restricts provider choice

Jennifer Morrow | Flickr

Missouri is poised to strip additional providers from a state-run program that provides family planning services for uninsured women.

The budget lawmakers are sending to Gov. Eric Greitens contains a provision that prohibits hospitals and clinics from participating in the Missouri Women's State-Funded Health Services Program if the organization also provides abortion services, as defined by a state law for sexual education in schools.

The budget also cuts the program’s funding by $4.6 million.

A similar amendment last year, filed by Rep. Robert Ross, R-Yukon, eliminated organizations that provide abortions for reasons other than saving the mother’s life. The new rule also would cut out organizations that can refer women to abortion providers, a nearly universal practice.

That means patients insured through the program, like Alecia Deal, 37, may need to find another doctor. Her coverage currently pays for checkups, birth control and cancer screenings at a Planned Parenthood clinic in south St. Louis, which does not provide abortions but can provide a referral. Though limited, it’s the only health coverage she has.

“I’m trying to wrap my mind around why the government has anything to say about it,” Deal said. 

Deal, a community health worker, signed up for the coverage after the birth of her third child in 2015. She became pregnant with her third child just three months after the birth of her second, and knew that access to contraception would be important afterwards. Though she doesn't personally agree with abortion, she said it's a strange reason for lawmakers to cut a provider out of a family planning program. 

“If you encourage family planning, it will reduce the need for abortion,” said Deal, who lives in St. Louis. “Not that it’s going to eradicate that, but it’s going to reduce it tremendously.”

The legislature's decision last year forced the Missouri Department of Social Services to give up an annual $8.3 million in federal funds for the state’s program for family planning, because federal Medicaid rules prevent states from restricting provider choice. The requirement that no participating organizations could provide abortions, except to save the life of the mother, eliminated several hospitals from the coverage network. The measure’s intended target, Planned Parenthood, emerged unscathed.

One provider excluded in the first wave of cuts was the Contraceptive Choice Center, which is part of the Washington University School of Medicine. The academic medical center also provides abortions in cases of severe fetal anomalies or when a mother’s life is in danger. The state no longer reimburses the clinic for pelvic exams, contraception and treatment for sexually transmitted diseases for women covered by the state’s family planning program, even though most of the center’s uninsured patients would qualify.

“Many of our patients would be upset to find out that they had to find another health-care provider,” wrote Dr. Tessa Madden, an OB-GYN for the center.  “We specifically have heard from patients that it can sometimes take months to be seen at other clinics.”

The center is continuing to see women who are covered by the state’s family planning program. But that's not financially sustainable for the long term, Madden said.

About 70,000 Missourians receive care through the state’s uninsured women’s health services program. Enrollees must be between the ages of 18 and 55, and with a family income below 201 percent of the federal poverty level — about $41,000 a year for a family of three.

Michelle Trupiano, executive director of the Missouri Family Health Council, said the new rule would likely exclude any provider that receives federal Title X funding. That’s because federal law requires doctors to provide neutral options counseling, upon request, for women who become pregnant.

“They are choosing to insert themselves in between the physician or provider relationship with women, where they have no place in being,” Trupiano said.

Ross, the bill’s sponsor, did not respond to requests for comment.

Corin Piazza, a mother of two in St. Joseph, has gone to the same clinic for almost a decade. She uses the state’s family planning coverage, and said switching her doctor would be devastating.

“I’d have nowhere to go, really,” Piazza said. “I completely understand how they feel about the whole abortion thing, but in the same sense, they also have to think about people who need help.” 

Follow Durrie on Twitter: @durrieB

Editor's note: An earlier version of this story incorrectly stated the amount of money to be cut from the program.