Back to center stage: ACA decision gives new significance to Medicaid family planning expansions.

If fully implemented the Affordable Care Act (ACA) would ideally give nearly everyone in the United States a pathway to insurance coverage. However negative experiences of health care reform in specific states such as Massachusetts and the Supreme Court’s decision to make the expansion of full-benefit Medicaid optional rather than mandatory for states may well mean that many states will fail to take up that option. These realities mean that the Medicaid family planning expansions now in place in 26 states will continue to have an important role to play and that in some states these programs may be the only coverage for which some low-income women will be eligible. These programs serve nearly three million clients a year and according to numerous state program evaluations and national analyses they have increased the degree and continuity of women’s contraceptive use which are important factors in reducing high rates of unintended pregnancy among low-income women. Using the six-year experiment with health care reform in Massachusetts which demonstrated that that the goal of providing universal health insurance coverage remains elusive this article addresses persistent gaps in coverage and eligibility filling the court-created void in family planning expansions and critical programs at risk.