[Congressional Record Volume 149, Number 106 (Thursday, July 17, 2003)]
[Senate]
[Pages S9596-S9598]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. CHAFEE (for himself and Mrs. Feinstein):
  S. 1429. A bill to amend title XIX of the Social Security Act to 
provide States with options for providing family planning services and 
supplies to individuals eligible for medical assistance under the 
medicaid program; to the Committee on Finance.
  Mr. CHAFEE. Mr. President, I am pleased to be joined today by Senator 
Feinstein in introducing the Family Planning State Empowerment Act of 
2003. This legislation would provide States with a mechanism to improve 
the health of low-income women and families by allowing States to 
expand family planning services to additional women under the Medicaid 
program.
  The Federal Government currently reimburses States for 90 percent of 
their expenditures for family planning services under Medicaid, due to 
the importance of these for low-income women. This reimbursement rate 
is higher than for most other health care services.
  Generally, women may qualify for Medicaid services, including family 
planning, in one of two ways: they have children and an income level 
below a threshold set by the State, ranging from 15 to 86 percent of 
the Federal poverty level; or they are pregnant and have incomes up to 
133 percent of the poverty level, federal law allows states to raise 
this income eligibility level to 185 percent, if they desire. If a 
woman qualifies because of pregnancy, she is automatically eligible for 
family planning services for sixty days following delivery. After those 
sixty days, the woman's Medicaid eligibility expires.
  If States want to provide Medicaid family planning services to 
additional populations of low-income women, they must apply to the 
Federal Government for a so-called ``1115'' waiver. These waivers allow 
States to establish demonstration projects in order to test new 
approaches to health care delivery in a manner that is budget-neutral 
to the Federal Government.
  To date, these waivers have enabled eighteen States to expand access 
to family planning services. Most of these waivers allow states to 
extend family planning to women beyond the sixty-day post-partum 
period. This allows many women to increase the length of time between 
births, which has significant health benefits for women and their 
children. For this reason, an Institute of Medicine report recommended 
that Medicaid should cover family planning services for two years 
following a delivery.
  Some of the waivers allow States to provide family planning to women 
based solely on income, regardless of whether they qualify for Medicaid 
due to pregnancy or children. In general, States have used the same 
income eligibility levels that apply to pregnant women, 133 percent or 
185 percent of the poverty level, creating continuity for both family 
planning and prenatal care services. These expanded services also help 
states reduce rates of unintended pregnancy and the need for abortion.
  My State of Rhode Island was one of the first States to obtain one of 
these waivers, and has had great success with it in terms of preventing 
unintended

[[Page S9597]]

pregnancies and improving public health in general. Rhode Island's 
waiver has averted 1,443 pregnancies from August 1994 through 1997, 
resulting in a savings to the state of $14.3 million. In addition, 
Rhode Island's waiver has assisted low-income women with spacing-out 
their births. The number of low-income women in Rhode Island with short 
inter-birth intervals, becoming pregnant within 18 months of having 
given birth, dropped from 41 percent in 1993 to 29 percent in 1999. The 
gap between Medicaid recipients and privately insured women was 11 
percent in 1993, compared with only 1 percent--almost negligible--in 
1999. As these statistics show, these waivers are extremely valuable 
and serve as a huge asset to the women's health, not only to my 
constituents but to constituents in the thirteen other states who 
currently benefit from these waivers.
  Unfortunately, the waiver process is extremely cumbersome and time 
consuming, taking up to three years for States to receive approval from 
the federal government. This may discourage States from applying for 
family planning waivers, or at the very least, delay them from 
providing important services to women.
  Our bill would rectify this problem by allowing States to extend 
family planning services through Medicaid without going through the 
waiver process. Eliminating the waiver requirement will facilitate 
State innovation and provide assistance to more low-income women.
  This bill will allow States to provide family planning services to 
women with incomes up to 185 percent of the Federal poverty level. For 
low-income, post-partum women, States will no longer be limited to 
providing them with only sixty days of family planning assistance. 
States may also provide family planning for up to one year to women who 
lose Medicaid-eligibility because of income.
  I urge my colleagues to join me in supporting this important 
legislation, and ask unanimous consent that the text of legislation be 
printed in the Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1429

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Family Planning State 
     Empowerment Act of 2003''.

     SEC. 2. STATE OPTION TO PROVIDE FAMILY PLANNING SERVICES AND 
                   SUPPLIES TO INDIVIDUALS WITH INCOMES THAT DO 
                   NOT EXCEED A STATE'S INCOME ELIGIBILITY LEVEL 
                   FOR MEDICAL ASSISTANCE.

       (a) In General.--Title XIX of the Social Security Act (42 
     U.S.C. 1396 et seq.) is amended--
       (1) by redesignating section 1935 as section 1936; and
       (2) by inserting after section 1934 the following:


    ``state option to provide family planning services and supplies

       ``Sec. 1935. (a) In General.--Subject to subsections (b) 
     and (c), a State may elect (through a State plan amendment) 
     to make medical assistance described in section 1905(a)(4)(C) 
     available to any individual whose family income does not 
     exceed the greater of--
       ``(1) 185 percent of the income official poverty line (as 
     defined by the Office of Management and Budget, and revised 
     annually in accordance with section 673(2) of the Community 
     Services Block Grant Act) applicable to a family of the size 
     involved; or
       ``(2) the eligibility income level (expressed as a percent 
     of such poverty line) that has been specified under a waiver 
     authorized by the Secretary or under section 1902(r)(2)), as 
     of October 1, 2003, for an individual to be eligible for 
     medical assistance under the State plan.
       ``(b) Comparability.--Medical assistance described in 
     section 1905(a)(4)(C) that is made available under a State 
     plan amendment under subsection (a) shall--
       ``(1) not be less in amount, duration, or scope than the 
     medical assistance described in that section that is made 
     available to any other individual under the State plan; and
       ``(2) be provided in accordance with the restrictions on 
     deductions, cost sharing, or similar charges imposed under 
     section 1916(a)(2)(D).
       ``(c) Option To Extend Coverage During a Post-Eligibility 
     Period.--
       ``(1) Initial period.--A State plan amendment made under 
     subsection (a) may provide that any individual who was 
     receiving medical assistance described in section 
     1905(a)(4)(C) as a result of such amendment, and who becomes 
     ineligible for such assistance because of hours of, or income 
     from, employment, may remain eligible for such medical 
     assistance through the end of the 6-month period that begins 
     on the first day the individual becomes so ineligible.
       ``(2) Additional extension.--A State plan amendment made 
     under subsection (a) may provide that any individual who has 
     received medical assistance described in section 
     1905(a)(4)(C) during the entire 6-month period described in 
     paragraph (1) may be extended coverage for such assistance 
     for a succeeding 6-month period.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     apply to medical assistance provided on and after October 1, 
     2003.

     SEC. 3. STATE OPTION TO EXTEND THE POSTPARTUM PERIOD FOR 
                   PROVISION OF FAMILY PLANNING SERVICES AND 
                   SUPPLIES.

       (a) In General.--Section 1902(e)(5) of the Social Security 
     Act (42 U.S.C. 1396a(e)(5)) is amended--
       (1) by striking ``eligible under the plan, as though'' and 
     inserting ``eligible under the plan--
       ``(A) as though'';
       (2) by striking the period and inserting ``; and''; and
       (3) by adding at the end the following:
       ``(B) for medical assistance described in section 
     1905(a)(4)(C) for so long as the family income of such woman 
     does not exceed the maximum income level established by the 
     State for the woman to be eligible for medical assistance 
     under the State plan (as a result of pregnancy or 
     otherwise).''.
       (b) Effective Date.--The amendments made by subsection (a) 
     apply to medical assistance provided on and after October 1, 
     2003.

  Mrs. FEINSTEIN. Mr. President, I rise today with Senator Chafee to 
introduce a bill to give States the flexibility to provide family 
planning services to low-income women who do not qualify for Medicaid.
  Under current law, in order to qualify for family planning services 
provided by the Medicaid program, a women would either have to have 
children and an income level below a threshold set by the State, 
ranging from 15-86 percent of the Federal poverty level, or be pregnant 
and have an income up to 133 percent of the poverty level; Federal law 
allows States to raise this income eligibility level to 185 percent, if 
they desire.
  If a woman qualifies because of pregnancy, she is automatically 
eligible for family planning services for 60 days following delivery. 
After those 60 days, the woman's Medicaid eligibility expires.
  If a State wants to provide Medicaid family planning services to 
additional populations of low-income women, they must apply to the 
Federal Government for a waiver. Currently, 18 States have waivers 
approved by the Federal Government. The waiver process is extremely 
cumbersome and time consuming, often taking up to three years to 
receive approval from the Federal Government.
  This bill would once and for all allow States to provide crucial 
family planning to low-income women under the Medicaid program. It 
would eliminate the waiver process for these services and would give 
authority back to the States to determine what populations of low 
income women they want to provide family planning services to.

  California currently receives $100 million annually, until 2004, as 
part of its five-year waiver to provide family planning services to low 
income women. with these funds, California provides services to more 
than 900,000 women each year.
  The State estimates that because of these services, at least 50,000 
unintended pregnancies are prevented each year.
  In addition to contraceptives, the family planning funds are used for 
sexually transmitted disease screening and treatment, HIV screening and 
counseling, basic infertility services and pregnancy testing and 
counseling.
  Officials involved in the program estimate that for every $1 invested 
in family planning, $3 are saved in pregnancy and health-care related 
costs.
  In California, it is estimated that providing low-income women with 
access to family planning will save the State more then $900 million 
over the course of the five-year waiver.
  I believe this legislation is more important now than ever.
  Each year, approximately 3 million pregnacies, or about half of all 
pregnancies, are unintended. Increasing access to family planning 
services could help avert these 3 million unintended pregnancies and 
all the decisions and costs associated with either continuing or 
terminating a pregnancy.
  Family planning services give women the necessary tools to space the 
births

[[Page S9598]]

of their children, which improves women's health and reduces rates of 
infant mortality.
  Medicaid family planning is also cost effective. For every $1 
invested in family planning, $3 are saved in pregnancy and health care-
related costs.
  Family planning and reproductive health services are much more than 
just accessing contraceptives. Services provided include screening and 
treatment for sexually transmitted diseases and HIV, basic inferility 
services and pregnancy testing and counseling. Women can receive pap 
smears and breast exams, which are crucial to detecting cervical and 
breast cancer.
  Low income women deserve access to family planning and reproductive 
health services. And States should not have to ask the Federal 
Government for permission to use Medicaid funds to provide these 
essential services.
  We can afford to shut the door on those who cannot otherwise afford 
family planning and reproductive health services.
  I urge my colleagues to join me in supporting this important 
legislation.
                                 ______