Medicaid Under Attack: Women May Lose Vital Source of Health Care Coverage

by Jan Erickson, Government Relations Director

March 14, 2005

The Bush administration and Republican budgeteers in Congress are poised to enact a budget resolution for the coming fiscal year that will require at least a $45 billion cut over ten years in Medicaid, the federal-state program that covers health care costs for 53 million low-income people. A $45 billion cut is equivalent to cutting off health care for 345,000 seniors or 1.8 million children, according to Families USA, a health care advocacy group.

In addition, the White House wants a re-structuring of the program that will eliminate guaranteed coverage of those who are eligible, placing more funding responsibilities on the states while further reducing federal contributions to the cost. Many governors have protested such changes, stressing that any additional demands on tight state budgets would require serious cuts in coverage. Medicaid constitutes, on average, about 22% of states' annual budgets.

Last year, health care advocates, including NOW, narrowly averted a bid by conservative budget cutters to slash Medicaid by an astonishing $392 billion over ten years! But it now appears that there will be a more deliberate and longer process to undermine and perhaps eventually eliminate the Medicaid program.

These short-sighted and mean-spirited actions will put at serious risk the health of millions of poor, disabled and older women across the country, limiting and perhaps eliminating their only source of health care coverage. Poor, elderly women whose long-term care is funded by Medicaid may face the most serious consequences.

Some 16 million women are covered by the program, which pays for a wide range of medical services throughout their lives. To be eligible under Medicaid, a person must have income below the poverty level and must also fall into one of these major categories: pregnant, parent with children under 18, over age 65, or disabled. In 2000, Congress passed a law that allowed states to extend their Medicaid coverage to uninsured women battling breast or cervical cancer. A range of other important health care services are optional and offered by some states.

Two-thirds of Medicaid's insured women are in their "reproductive years," which includes all women aged 19-44. The program covers a range of services including: family planning (in some states), pap smears and other preventative screening, pregnancy related care (prenatal, childbirth, postpartum), and sexually-transmitted infection (STI) testing and treatment. The federal Hyde amendment prohibits federal spending on abortions except in cases of rape, incest, or serious risk to the woman's life. However, 17 states have chosen to use state funds to provide abortion coverage in limited circumstances.

Medicaid is one of the largest payers of pregnancy-related services. It pays for prenatal care for more than one-third of the pregnancies in the United States. In Arkansas, New Mexico, West Virginia, and Mississippi, Medicaid coverage accounts for over half of all pregnancies, according to the Henry J. Kaiser Foundation.

In only 19 states, family planning is covered by Medicaid. The federal government established the Federal Medical Assistance Percentage, which awards states 90 cents for every 10 cents they spend toward family planning, which can be classified as anything aimed at achieving a family planning purpose. However, most states do not cover preventative services, i.e. preventative contraceptives, pap smears, STD testing, and counseling as part of the family planning benefit.

For more information on Medicaid and details on your state's Medicaid coverage, visit StateHealthFacts.org. For more facts regarding women and Medicaid, see the Henry J. Kaiser Family Foundation's fact sheet on Women's Health Insurance Coverage or the Kaiser Foundation's issue brief on Medicaid's Role for Women.