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Protecting Medicaid Beneficiaries’ Freedom to Choose Providers

The Centers for Medicare and Medicaid Services (CMS) today issued a welcome reminder to state Medicaid directors that federal law gives Medicaid beneficiaries freedom of choice of their health care providers.  Some states have tried to bar Planned Parenthood from their Medicaid programs by claiming it isn’t qualified simply because it also provides abortions, separately from its participation in Medicaid.  (Federal Medicaid funds can’t be used to pay for abortions except in cases of danger to the life of the mother, rape, or incest.)

As we’ve explained, courts have clearly ruled that any state restrictions on which providers can participate in Medicaid must be based on the provider’s “capability of performing the needed medical services in a professionally competent, safe, legal, and ethical manner.”  Today’s CMS letter explains that this means states must have solid evidence of misconduct that calls into question the provider’s ability to provide Medicaid-covered services or appropriately bill for them.  Separately providing abortion services does not constitute such evidence.

The letter is especially important for women seeking family planning services.  While states can limit beneficiaries’ choice of providers when they provide health care through managed care arrangements, they can’t restrict freedom of choice for family planning services.  Giving women a choice of their own family planning providers ensures they can receive these services where they feel comfortable, regardless of whether the provider is part of the network in their managed care plan.

Planned Parenthood is one of the nation’s largest providers of family planning services for low-income Americans.  Today’s letter makes it clear that states can’t keep women from getting their care at Planned Parenthood for reasons unrelated to its fitness to provide Medicaid-covered services.