Medicaid Regs are not to be trifled with

Last summer, when I was guest blogging over at WaPo, I wrote about some developments in my home state of Indiana concerning abortion. Specifically, Indiana was trying to pass a law that would no longer allow a provider to receive funds for any services at all if they also provided abortion. Specifically, this was a bill to defund Planned Parenthood. I was concerned, because this could be a potential problem:

[A]ccording to the Indiana Legislative Services Agency (pdf):

The Family and Social Services Administration (FSSA) reports that federal law requires state Medicaid plans provide any eligible individual medical assistance and that they can obtain such assistance from any institution, agency, community pharmacy, or person, qualified to perform the service(s) required. This also includes an organization which provides such services, or arranges for their availability, on a prepayment basis. Federal law permits states to define a qualified provider, but requires that this definition is related to a provider’s ability to perform a service and not what services are provided.

It seems that federal law stipulates that state Medicaid programs have to allow recipients to obtain services from any qualified provider. States can define “qualified,” but only with respect to whether they can actually provide the service. In other words, it appears they can’t be ruled “not qualified” because they also provide abortions.

Medicaid regulations are pretty specific. They’re set up so states can’t cherry pick providers. I feared that if Indiana went through with this, they they could lose Medicaid funding.

I should have been watching Texas. They did it:

After Texas blocked abortion providers’ participation in its Medicaid Women’s Health Program, the White House officially notified the state Thursday afternoon that it will pull all funds from the program, which totalled about $39 million last year.

Twenty-nine states participate in the Medicaid’s Women Health Program, which extends Medicaid coverage for reproductive health services to lower-income women who do not qualify for the rest of the entitlement program’s benefits. In Texas, the program served about 130,000 women, with the federal government footing 90 percent of the bill. About half of the clinics participating in the program would have been disqualified by the new legislation.

Gov. Perry reports that he will come up with the money to cover the services provided to these women elsewhere. I have no idea where he will find it, as Texas is already running a $4 billion Medicad shortfall, but I wish him luck.

When the federal government is paying 90% of something, I’d take what they say seriously. I said they were playing hardball last June. They still seem to be.


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