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Missouri issues new Medicaid rules for abortion providers

Planned Parenthood’s clinic in St. Louis, seen in this July 2020 photograph, is the only place that provides abortions in Missouri.
Bill Greenblatt
Planned Parenthood’s clinic in St. Louis, shown in July 2020, is the only place that provides abortions in Missouri.

Missouri’s Department of Health and Senior Services is issuing new emergency rules tightening regulation of the state’s abortion providers.

Starting next week, state inspectors will report any rule violations by abortion providers directly to the state’s Medicaid auditors. After that, the state could pull Medicaid funding. Medicaid is the government-funded insurance program for low-income people and families.

The new rules are in line with recommendations from a Republican-led Missouri Senate committee on the state's Medicaid program and "the protection of unborn life." Members of the committee on Thursday are meeting with officials from the MO HealthNet, the state’s Medicaid program.

Planned Parenthood’s clinic in St. Louis is the only place that provides abortions in Missouri, at its clinic in the Central West End. However, if it loses its funding, that could affect the organization’s other locations. The organization accepts Medicaid and provides pap smears, checkups and other health procedures at other clinics throughout the state.

No state or federal funds can be used to pay for abortions, except in some extreme cases.

Abortion-rights advocates say the new rules are an attempt by state lawmakers to curb abortion access in the state.

“The State of Missouri is still clearly singling out Planned Parenthood and using a regulatory scheme that we’ve watched them abuse in the past in an unlawful manner, time and time again,” said Bonyen Lee-Gilmore, vice president of strategy and communication for Planned Parenthood of the St. Louis Region and Southwest Missouri.

There are no new rules for abortion providers in the emergency rules, she said.

Existing rules that DHSS cites in the new regulations include a 2014 provision that requires people to wait 72 hours between receiving a state-mandated pelvic exam and getting an abortion from the same physician, rules about accurate record-keeping and sterilization of equipment, and the requirement that all employees participate in an annual fire drill.

Inspectors finding violations of any of these rules will immediately report them to the state’s Medicaid regulators, according to the new emergency regulations.

But the new reporting requirement isn’t necessary because inspection reports are already publicly available, Lee-Gilmore said.

The September reportfrom the Senate Interim Committee to Medicaid Accountability & Taxpayer Protection also recommended that “ethical violations” by Planned Parenthood or other abortion providers in other states would serve as a basis for barring them from receiving state Medicaid funds.

“I'm pro-life — always have been and always will be,” Sen. Karla Eslinger, R-Wasola, wrote on Twitter on Tuesday. “The vast majority of the people I represent in the state senate are pro-life. The steps our committee recommends are important, meaningful and essential to fully protect life. They should be enacted now.”

Close to 20% of Planned Parenthood’s patients use Medicaid, Lee-Gilmore said.

“This really is about the impact to patients in the most marginalized communities in the state — this is an attack on them,” she said. “Those who rely most on Medicaid for healthcare are the ones who will be hurt the most.”

State lawmakers have been attempting to bar Medicaid funds from organizations that provide abortions for years.

The legislature in the past attempted to cut funding for Planned Parenthood by inserting language into the 2018 state budget that barred state funds, including those from the state’s Medicaid program MO HealthNet, from going to any abortion provider.

The Missouri Supreme Court in 2020 affirmed a lower court ruling that found the provision was unconstitutional and ordered the state to pay up.

The state in 2019 used health inspections as a tool to refuse to renew the license for Reproductive Health Services to operate.

The resulting legal fight lasted for months. A state administrator found the clinic had not violated any rules or performed any unsafe abortions, and the Central West End clinic remains able to provide the procedures.

Follow Sarah on Twitter:@petit_smudge

Sarah Fentem is the health reporter at St. Louis Public Radio.