State Fixes Funding Problem for Poor Women’s Contraceptive Care

The Affordable Care Act expanded the state Medicaid program to 350,000 new members, but it didn’t pay providers as well as a separate reproductive health program for uninsured women, provoking concerns from Rep. Mitch Greenlick that the state may be inadvertently hurting Planned Parenthood and other women’s health providers.

The state has stepped in to solve an unintended consequence of the Affordable Care Act -- reproductive health providers had gotten paid less to cover women insured by Medicaid than they did from an existing state program designed specifically to offer free contraceptive services.

A state program called OregonContraceptiveCare, or CCare, for short, offers free contraceptive care, including a doctor’s visit, birth control pills and intrauterine devices to uninsured women with incomes below 250 percent of the federal poverty line. 

But with the Affordable Care Act expanding Medicaid coverage to anyone up to 138 percent of the poverty line --  just shy of 350,000 Oregonians, many women now pay for their contraceptive care at Planned Parenthood and other clinics through the Oregon Health Plan.

Helene Rimberg, a state reproductive health manager, said the CCare program has seen its clientele drop 30 percent since the Oregon Health Plan expansion.

The new health insurance coverage may be a godsend for poor women, it has negatively impacted their providers -- the state pays $150 a visit through CCare, but had been paying only $78 through the Oregon Health Plan.

“It was a very big impact for the providers,” Rimberg said.

Both funding streams are largely federal, although CCare traditionally had a higher match rate, allowing the state to be more generous with providers. The money now used to expand the Oregon Health Plan has been entirely federal, but the stingy rate for contraceptive care visits remained in place when the expansion hit at the start of the year.

“A vast majority of our patients utilize some kind of public funding,” said Liz Delapoer, spokeswoman for Planned Parenthood Columbia Willamette.

The problem drew the attention of Rep. Mitch Greenlick, D-Portland, who aired his concerns to Public Health Director Lillian Shirley at a public meeting Wednesday.

Planned Parenthood recently closed three clinics in Oregon along with one in Vancouver, and Greenlick was worried the funding shift may be cutting into their ability to stay in business.

But in April, Oregon’s Public Health Division met with the Division of Medical Assistance Programs, which sets the rates, and that division agreed to raise the payment to $135 for a contraceptive management office visit, effective June 1, according to Rimberg. The medical assistance division also agreed to reimburse providers for the $52 difference dating back to April.

The payments impact providers who have contracts with coordinated care organizations less directly; CCOs pay primary care providers a global payment to cover all the basic healthcare costs of their assigned members. But women on the Oregon Health Plan are free to seek any provider for contraceptive services and are not bound to the provider who attends to their other healthcare needs.

If a contraceptive service provider does not have a contract with a CCO, the state pays them the fixed rate per visit.

Delapoer said the effect of this funding discrepancy was negligible for her organization. She said the retroactive reimbursements that went back to April largely resolved the issue, which left only three months where Planned Parenthood as well as county health departments were getting paid the lower rate.

According to The Oregonian, the struggles of Planned Parenthood are more complicated than state funding for contraceptive care. As the clinics fit more women with long-term contraceptives such as intrauterine devices, women need to make fewer visits to their clinics to renew their prescriptions for oral contraceptives. Planned Parenthood has seen a 27 percent drop in visits since 2012.

Chris can be reached at [email protected].

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