Breaking new ground: ingenuity and innovation in Medicaid family planning expansions.

Through three waves of expansions spanning more than two decades Medicaid has opened its doors to large numbers of women and children whose low family incomes were nonetheless too high to meet the strict eligibility requirements for the Medicaid program. In implementing these expansions policymakers and providers in states and communities across the country have confronted myriad challenges in their efforts to enroll and serve newly eligible groups. Expansions of Medicaid eligibility for family planning the newest of these expansions have both built upon these earlier efforts and broken critical new ground on issues that have bedeviled policymakers and providers for years. In many ways this progress has come through developing new and unique partnerships between state programs and providers and by finding creative ways to leverage state dollars and funding through the federal Title X program. When Medicaid was first established in 1965 the low-income families covered by the program generally were headed by single mothers receiving welfare benefits. In the 1980s Congress broke the welfare-Medicaid link by first allowing and later requiring states to extend eligibility for Medicaid-covered pregnancy-related care (including postpartum family planning services) to women with incomes up to 133% of the federal poverty level-far above most states regular Medicaid eligibility ceiling. The expansions for pregnant women pioneered what was for Medicaid a wholly new emphasis: actively reaching out to potential clients in an attempt to locate and enroll in the program as many eligible people as possible. The family planning expansions have built upon this foundation. In the process they have developed important innovations of their own including a focus on program Web sites. (excerpt)