Analysis Health Systems

How Louisiana Slashed Medicaid Funding for Pregnant Women and Blamed a Typo

Katherine Don

Louisiana health officials appear to have cut funding for the state’s Medicaid program for pregnant women based on a typo on the Affordable Care Act website, Healthcare.gov.

Over the last several months, the Louisiana Department of Health and Hospitals made a series of announcements about LaMOMS, the state’s Medicaid program for pregnant women—first announcing cuts to the program, then a plan to reevaluate those cuts, and then that the cuts were being rescinded. Health Secretary Kathy Kliebert explained in a series of interviews with the Baton Rouge Advocate that this seesaw of decisions was caused by an unspecified change in federal policy related to the Affordable Care Act (ACA).

The $11 million in cuts, which passed as part of the 2013-2014 state budget in June, were added back into the budget in November. But the reversal dictated that the category of women who were slated to be dropped from LaMOMS are now instead covered through the state’s Medicaid program for children, LaCHIP. This means that the Medicaid funds are now technically for “unborn children,” not for the pregnant women themselves, and these women will lose postpartum care coverage. These changes went into effect in January.

Rewire spoke with the Louisiana health department and ACA policy experts for clarification on why an ACA policy affected Louisiana’s longstanding LaMOMS program. A closer look reveals an odd story wherein officials planned to cut the LaMOMS budget by taking advantage of an ACA loophole—a loophole that, it turns out, did not exist. Rather, state health officials appear to have changed the state’s Medicaid funding of pregnant women based on a typo on the ACA website, Healthcare.gov.

When Louisiana officials discovered their mistake, they blamed the mixup on the Federal Centers for Medicare and Medicaid Services (CMS), the department that oversees ACA implementation.

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The saga represents a troubling example of the anti-ACA, anti-women maneuverings of the administration of Louisiana Gov. Bobby Jindal.

The Federal Policy Change That Wasn’t

The initial Medicaid cuts that passed in Louisiana’s 2013-2014 state budget established new income eligibility requirements that drastically reduced the number of pregnant women eligible for Medicaid in Louisiana. Previously, women earning up to 200 percent of the federal poverty level (FPL)—or up to $22,980 annually—were eligible for prenatal, childbirth, and 60 days of postpartum care through LaMOMS. But the reductions were slated to reduce eligibility to 133 percent, creating a new gap in coverage for women earning between $15,280 and $22,980.

Federal law requires that all states provide Medicaid to pregnant women, with an eligibility cap of at least 133 percent. The vast majority of states opt for much higher thresholds, as high as 380 percent.

“Eligibility is higher for pregnancy because we consider this to be a particularly important time period for health outcomes,” Laura Gaydos, assistant professor in the Department of Health Policy and Management at Emory University, told Rewire. “This is something that pretty much everyone agrees about.”

The reason Louisiana’s health department provided for the LaMOMS reduction was that women in the 133 to 200 percent FPL range are now eligible for subsidies on the federal health marketplaces under the ACA (which provide subsidies to individuals earning between 100 and 400 percent the FPL). In other words, the state didn’t want to continue funding Medicaid for women who might also be eligible for ACA subsidies.

Jan Moller, director of the Louisiana Budget Project, a nonprofit that monitors government spending, told Rewire that prenatal care “has been a huge priority for this administration because Louisiana ranks very poorly with birth outcomes.” Moller’s understanding of the cuts was that Louisiana officials believed women in the 133 to 200 percent range would sign up for private insurance on the ACA marketplace. “And of course, this was a way for the state to save money,” he added.

But there was a glaring problem with this strategy. What would happen if an uninsured woman didn’t enroll during ACA’s annual open enrollment period, and then became pregnant? She can’t sign up on the ACA, and she now no longer qualifies for Medicaid, which provides immediate access to no-cost care. Such a woman would be left with virtually no options for receiving care.

It turns out that Louisiana officials were operating under the false belief that becoming pregnant is a circumstance that triggers a “special enrollment period,” allowing women to sign up on the ACA marketplaces outside of the open enrollment period. When officials later realized this wasn’t the case, they reversed their Medicaid cuts, alleging that a change in federal policy had caused their confusion. As reported in an October Baton Rouge Advocate article titled “Rules Change Impacts Low-Income Pregnant Women”:

The federal Centers for Medicare and Medicaid Services has thrown the state a curve … a new interpretation of the term “qualifying life event” would leave some of those women in the gap without prenatal care, [health secretary] Kliebert said. The definition of a qualifying event to enroll in the new health insurance exchange outside of the open enrollment period removed the event of becoming pregnant.

“Federal policy messed us up,” Health Secretary Kliebert said in November, during her announcement that the previous Medicaid eligibility levels would be restored.

However, a Centers for Medicare and Medicaid Services spokesperson told Rewire that there had been no policy change.

In order to understand the issue at hand, it’s important to examine the concept of special enrollment periods, which are not unique to the ACA; anyone who has experience enrolling in private health insurance will be somewhat familiar. Specific events, such as losing a job, getting a new job, or gaining a dependent, trigger special enrollment periods that temporarily allow individuals or families to sign up for insurance outside of open enrollment periods.

For ACA insurance plans, pregnancy is not a qualifying life event. So Kliebert’s assertion that a new federal policy removed pregnancy from the list of such events is impossible: It couldn’t be removed from a list that it was never on. The rules for qualifying life events are available to the public and listed in subpart D of the Affordable Care Act.

“In no insurance situation that I’m aware of, whether in the ACA or outside of the ACA, is pregnancy a qualifying life event,” Professor Gaydos told Rewire.

Indeed, pregnancy as a qualifying life event runs counter to the fundamental logic of private insurance plans. Insurance companies don’t typically allow individuals to enroll upon changes in health status, such as becoming pregnant, because that would cause “adverse selection,” a concept predicting that costs throughout the market increase if individuals sign up for insurance only when they become sick. Medicaid access for uninsured pregnant women is thus a unique system allowing low-income, uninsured women to gain immediate coverage upon becoming pregnant.

“You would not have a special enrollment period for women who become pregnant,” said Judy Solomon, vice president for health policy at the Center on Budget and Policy Priorities. “I don’t know what Louisiana could have meant when they thought pregnancy was included.”

The Culprit Behind the Confusion

Rewire contacted the Louisiana Department of Health and Hospitals for information about the federal policy change that led to it questioning the LaMOMS cuts. The department provided the following in an email statement from Secretary Kliebert:

The federal government’s website recently changed the definition of a qualifying life event to enroll in the new health insurance exchange outside of the open enrollment period, removing the event of “becoming pregnant,” … After seeking clarification, we’ve received multiple and conflicting answers … Our last communication with federal officials indicated that becoming pregnant will not trigger a special enrollment period for women.

A federal website hadn’t been mentioned in the Advocate articles, so this was a clue about the persistently vague references to a change in “federal policy.” The mystery was solved when a health department official told Rewire that the answer can be found in Kliebert’s September 2013 testimony before Congress regarding her department’s concerns about the ACA.

During her congressional testimony, Kliebert stated that “until very recently, HHS’s primary Exchange website, Healthcare.gov, had included in its definition of qualifying life event the example of when you ‘become pregnant.’ However, the information on the site recently changed to state that it is the birth of the baby that qualifies the woman for coverage.”

Kliebert included two screenshots that she said were taken “weeks apart” revealing photos of the same webpage, with one omitting “become pregnant” from the list of qualifying life events:

healthcare_gov

These screen shots aren’t dated, but it appears that for some unknown amount of time, this piece of misinformation was posted at Healthcare.gov. Kliebert’s testimony was in September, so it seems that this rather serious error was fixed prior to the website’s October 1 public launch.

In her anti-ACA testimony, Kliebert presented the Healthcare.gov error as an example of the difficulty her department experiences when communicating with federal officials. However, Kliebert did not mention that the glossary error had prompted Louisiana to revoke Medicaid coverage for low-income, uninsured pregnant women.

It’s unclear why Louisiana officials hadn’t consulted the rules of the ACA itself or contacted health-care experts before going ahead with the Medicaid cuts.

“A glossary is not a law,” said the Center on Budget and Policy Priorities’ Judy Solomon. “Pregnancy is not on the list. You can Google it.”

“It sounds like misinformation was presented [at Healthcare.gov], and then they did not go far enough in looking into the actual rule from CMS [Centers for Medicare and Medicaid],” said Professor Gaydos.

Yet, in lieu of admitting the mistake, Kliebert spoke to the press about an unnamed “federal policy” that “messed up” decisions surrounding the LaMOMS program.

Kliebert is an appointee and close ally of Republican Gov. Jindal, a vocal opponent of the ACA and the Medicaid expansion. In his Wall Street Journal op-ed about the health-care law, Jindal pinpointed the bureaucracy of state-federal interaction as the prime problem with the ACA:

Fifty-five working days before the launch of the ObamaCare health-insurance exchanges on Oct. 1, the administration published a 600-page final rule that employers, individuals and states are expected to follow in determining eligibility for millions of Americans. Rather than lending clarity to a troubled project, the guidelines only further complicated it. If the experience of those working with the ObamaCare implementation at the state level had been taken into account, progress might have been possible, but the administration has treated states with mistrust.

What’s so unsettling about the LaMOMS debacle is that Jindal’s administration was fast to cut LaMOMS funds in the dubious hope that women would instead receive subsidies on the very federal marketplaces that Jindal vehemently opposes. Jindal has deemed the ACA a “one-size-fits-all approach” that impedes a governor’s ability to “care for our most vulnerable citizens,” and yet was eager to siphon pregnant women into the ACA marketplace—and then blame the ACA when it didn’t work out, as if federal officials had forced the cuts onto LaMOMS in the first place.

The Jindal administration performed a similar about-face last summer. They quietly applied to participate in Community First Choice, a little-known ACA program that increases federal Medicaid funds for disabled and elderly care services. But then they withdrew the application, citing “new federal rules” and “complicated federal stipulations.” There is speculation that the real reason behind the withdrawal was presidential-hopeful Jindal’s reticence to be caught with his hand in ACA’s cookie jar.

The LaMOMS changes are part of a long list of Jindal administration cuts to health services for moms and children. In the 2012-13 budget, the state eliminated funds for dental services for pregnant women, an in-home nursing program to educate moms about infant care, and mental health services for low-income children. Further Medicaid cuts enacted this January included complete closure of the state’s Disability Medicaid program. Louisiana is thus not merely among the 25 states refusing to join the Medicaid expansion—it’s also cutting existing Medicaid programs, joining Wisconsin and Maine as the only three states to decline the expansion while at the same time dramatically reducing existing programs.

The Aftermath for Louisiana Women

Although the LaMOMS cuts were technically reversed, women will still be affected: Those in the 133 to 200 percent FPL range will now receive Medicaid through the state’s Medicaid fund for children, rather than through LaMOMS. Since the unborn fetuses will now be the ones receiving Medicaid, it’s unclear whether health services that don’t directly affect the fetus will be covered. Further, women will no longer receive the 60 days of postpartum care that is required through LaMOMS.

Louisiana has the second highest infant mortality rate in the nation, and infants born to mothers who do not receive prenatal care are five times more likely to die. In early November, when Louisiana’s health department was still considering whether to rescind the LaMOMS cuts, March of Dimes released new statistics on preterm birth, showing that Louisiana had improved very little despite pledges to address the problem.

“We urge policy-makers to expand insurance coverage, including Medicaid, for women of childbearing age,” the March of Dimes wrote on its “F” grade report card for Louisiana.

In the area of maternal health, Louisiana’s situation is so bad that the state was singled out for censure at last year’s UN General Assembly Millennium Development meeting on maternal health. The state has high rates of maternal death, too few practicing obstetricians, and a high proportion of uninsured women—27 percent of women of child-bearing age have no insurance, according to the Centers for Disease Control and Prevention. Given these serious problems, it’s alarming that LaMOMS was ever considered a target for budget reductions.

Uninsured Louisianans in the 100 to 400 percent FPL range are indeed now eligible for ACA subsidies. But for those who don’t enroll in the ACA marketplace during open enrollment and then become pregnant, it’s important that Medicaid continue to provide these women with free, immediate care.

In most Republican-governed states, pregnant women are eligible for Medicaid only during their pregnancy, but are then dropped from the program. This is the case in Louisiana, which provides little Medicaid to non-disabled adults: Only adults with dependent children who earn up to $2,727 a year are eligible. This means that if a low-income woman earns more than $2,727, she loses her Medicaid coverage 60 days after giving birth, when LaMOMS coverage ends.

Some 242,000 Louisianans would gain insurance if the state participated in Medicaid expansion.

“What’s really unfortunate is you have a lot of very low-income women in Louisiana who have no opportunity to get [Medicaid] coverage until they are pregnant,” Solomon said. “These women need coverage.”

News Abortion

Louisiana GOP Focuses on Anti-Choice Measures Amid Budget Crisis

Teddy Wilson

The proposals include a bill to ban the donation of fetal tissue and a measure to extended the state’s forced waiting period from 24 hours to 72 hours for a pregnant person seeking abortion care.

Louisiana Republicans found the time to pre-file an assortment of anti-choice bills for the upcoming regular legislative session in the midst of a special legislative session focused on the state’s budget crisis.

The GOP proposals include a bill to ban the donation of fetal tissue and a measure to extended the state’s forced waiting period for a person seeking abortion care from 24 hours to 72 hours.

State lawmakers have until Wednesday at 6 p.m. to determine a solution for the state’s $940 million budget crisis. In the meantime, ten bills to restrict reproductive rights have been pre-filed ahead of the state’s regular legislative session, which begins March 14.

“Clearly legislators will continue to attack women’s access to abortion,” Amy Irvin, executive director of the New Orleans Abortion Fund, told Rewire. “Given the emergency of the budget crisis and the potential impact on women and families in Louisiana, it is appalling that legislators have spent their time drafting bills to further limit access to safe and legal reproductive health care.”

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Among the pre-filed bills is HB 386, sponsored by Rep. Frank Hoffmann (R-West Monroe). State law in Louisiana already mandates that prior to terminating a pregnancy, a pregnant person must be given written materials published by the state, which list agencies offering “alternatives to abortion.” HB 386 extends the time a patient must wait between receiving those materials and getting abortion care from 24 hours to 72.

Louisiana would join five other states that force pregnant people to wait three days to receive abortion care. Missouri, North Carolina, Oklahoma, South Dakota, and Utah all have 72-hour waiting periods.

“It is medically unnecessary to wait 72 hours, just as it is to wait 24 hours,” Irvin said.

Medical research charges that waiting periods are detrimental to a pregnant person’s health. At least one study concluded that any delay in a pregnant person terminating a pregnancy increases the health risk and cost of abortion care.

A pregnant person should be provided with abortion care as soon as possible once the decision is made to terminate a pregnancy, according to recommendations by the World Health Organization.

The bill includes an exception for pregnant people who certify in writing that they live “one hundred fifty miles or more” from the nearest licensed clinic that provides abortion services. They would be forced to comply with a 24-hour waiting period, not a 72-hour waiting period. 

Pregnant people would continue to be exempt from the mandatory waiting period and forced counseling in the case of a “medical emergency.” Under state law, a medical emergency is defined as when the “continuation of the pregnancy poses an immediate threat and grave risk to the life or permanent physical health of the pregnant woman.”

There have been four bills pre-filed that would regulate the handling of fetal tissue after an abortion procedure. These include HB 618, sponsored by Rep. Tom Willmott (R-Kenner); HB 672, sponsored by Rep. Paula Davis (R-Baton Rouge); HB 815, sponsored by Rep. Julie Stokes (R-Kenner); and SB 33, sponsored by Sen. Ryan Gatti (R-Bossier City).

Legislation targeting the use of fetal tissue has appeared in many state legislatures controlled by Republicans.

These bills stem from discredited allegations made by the anti-choice front group known as the Center for Medical Progress (CMP), which began publishing deceptively edited and surreptitiously recorded videos in 2015. CMP’s smear campaign charged that Planned Parenthood violated laws governing the sale of fetal tissue. GOP-led investigations nationwide have turned up no wrongdoing on the part of Planned Parenthood, and CMP’s leaders have been indicted on felony charges related to the smear videos.

Former Gov. Bobby Jindal’s (R) administration used the CMP videos as justification to strip Medicaid payments from Planned Parenthood health-care clinics in Louisiana. A federal court blocked Jindal’s efforts.

Rep. Katrina Jackson (D-Monroe), who in 2014 authored the state’s Texas-style admitting privileges law, has sponsored another piece of legislation that targets clinics providing abortion services. HB 488 would require physicians offering abortion care to be “board-certified or board-eligible” in obstetrics and gynecology or family medicine. The American College of Obstetricians and Gynecologists opposes requirements like these; it has noted that “clinicians in many medical specialties can provide safe abortion services.”

HB 73, sponsored by Rep. Jerome Richard (I-Thibodaux), would join a growing number of bills introduced in state legislatures designed to criminalize pregnant people. The bill would charge pregnant people with “second degree cruelty to juveniles” if they are found to have used a controlled substance while pregnant.

A handful of bills have been pre-filed that would ban organizations that provide abortion services or contract with abortion providers from receiving state funding. This includes HB 606, sponsored by Hoffmann; HB 889, sponsored by Rep. Alan Seabaugh (R-Shreveport); and SB 264, sponsored by Sen. Fred Mills, Jr (R-St. Martinville).

Irvin called the filing of so many anti-choice bills a “race to the bottom,” especially in light of the Supreme Court blocking the state from enforcing a law that would leave the state with only one abortion provider. A federal district court judge has blocked efforts by Louisiana GOP legislators to cut off funding to Planned Parenthood health-care facilities.

The anti-choice bills have been referred to various house and senate committees, were they await further action. Republicans hold a 25-14 advantage in the state senate and a 61-42 majority in the house. 

Analysis Abortion

Attacks on Abortion Rights Continued in 2015, Ensnaring Family Planning Funding and Fetal Tissue Research

Rachel Benson Gold & Elizabeth Nash

The year will be remembered not only because 17 states enacted a total of 57 new abortion restrictions, but also because the politics of abortion ensnared family planning programs, providers, and life-saving fetal tissue research.

During 2015’s state legislative sessions, lawmakers considered 514 provisions related to abortion; the vast majority of these measures—396 in 46 states—sought to restrict access to abortion services. The year will be remembered not only because 17 states enacted a total of 57 new abortion restrictions, but also because the politics of abortion ensnared family planning programs and providers, as well as critical, life-saving fetal tissue research.

2015 may also be memorable for setting the stage for what is widely anticipated to be one of the most significant Supreme Court rulings on abortion since 1992. In November, the Court agreed to hear a challenge to a Texas law requiring abortion providers to adhere to the standards set for ambulatory surgical centers and to have admitting privileges at a local hospital. At stake is the question of how far states may go in regulating abortion before their actions amount to an unconstitutional “undue burden” on women’s ability to access care. The Court will hear the case in March, with a decision expected in June; it is still considering whether to review a Mississippi admitting-privileges law. (Also in 2016, the Court will revisit the contraceptive coverage guarantee under the Affordable Care Act, weighing its importance and approach against the contention of religiously affiliated employers that they deserve to be entirely exempt from the law.)

At the same time, several states made important advances in 2015 on other sexual and reproductive health and rights issues. Some of the new provisions include measures that allow women to obtain a full year’s worth of prescription contraceptives at one time from a pharmacy, that allow a provider to treat a patient’s partner for an STI without first seeing the patient, that prohibit the use of “conversion therapy” with minors, and that expand access to dating or sexual violence education. See our full analysis for details.

Access to Abortion Services

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Including the 57 abortion restrictions enacted in 2015, states have adopted 288 abortion restrictions just since the 2010 midterm elections swept abortion opponents into power in state capitals across the country. To put that number in context, states adopted nearly as many abortion restrictions during the last five years as they did during the entire previous 15 years. Moreover, the sheer number of new restrictions enacted in 2015 makes it clear that this sustained assault on abortion access shows no signs of abating.

StateTrends2015-restrictions

The 288 new restrictions enacted since 2010 include a broad range of approaches, from banning certain types of abortions to putting restrictions on the providers allowed to perform the procedures to limiting insurance coverage.

StateTrends2015-access

Thirty-one states—spanning all regions of the country—enacted at least one abortion restriction during the last five years. The ten states that enacted at least ten new restrictions together accounted for 60 percent of the 288 new abortion restrictions adopted over the last five years. These states are overwhelmingly located in the South and the Midwest, and it is likely that access to services for women in these regions has been impacted significantly. Four states—Arkansas, Indiana, Kansas, and Oklahoma—each enacted at least 20 new abortion restrictions, making this handful of states, which together adopted 94 new restrictions, responsible for a third of all abortion restrictions enacted nationwide over the last five years. Kansas has the dubious distinction of leading the pack with 30 new abortion restrictions since 2010.

heat map

Although the 57 new abortion restrictions enacted during 2015 include a wide range of provisions, four topics stood out as the subject of particular attention among lawmakers:

1. Counseling and Waiting Periods

Five states adopted new (Florida and Tennessee) or lengthened existing (Arkansas, North Carolina, and Oklahoma) waiting period legislation in 2015. (The new Florida law has been temporarily blocked by the courts; the Oklahoma law is also being challenged, but a state court allowed it to go into effect while the case is pending.) Including these new laws, 27 states have waiting periods in effect. The new laws in Florida and Tennessee require the pregnant person to receive state-mandated abortion counseling in person, meaning that she must make two separate trips to obtain an abortion. With enforcement of the Florida law blocked, 13 states have two-trip requirements in effect.

2. Medication Abortion

Three states sought to use longstanding strategies to restrict access to medication abortion. Arkansas, Idaho, and Kansas enacted new measures banning the use of telemedicine for the provision of medication abortion. Arkansas also mandated use of the regimen specified in the FDA-approved labeling, which bans the use of the newer evidence-based regimen that is less costly, has fewer side effects, and can be used several days later in pregnancy; the law is not in effect due to a court case. Currently, 18 states ban the use of telemedicine and four require providers to follow an outdated medication abortion regimen.

Arizona and Arkansas debuted a new approach to discourage a woman from obtaining a medication abortion. Both states adopted laws requiring doctors to counsel women that the abortion could be stopped if the woman takes a high dose of progesterone after receiving the first of the two drugs included in the medication abortion regimen. According to the American Congress of Obstetricians and Gynecologists, this new approach is based on scant scientific evidence; it relies on a single flawed study of only six cases that did not have oversight by an institutional review board. The Arizona law is blocked pending a legal challenge; the Arkansas law is in effect.

3. Abortions After the First Trimester

Anti-choice lawmakers unveiled a new strategy in 2015 by moving to ban the use of the procedure used most often for second-trimester abortions. Kansas and Oklahoma both enacted measures to ban this safe and medically proven method that has long been used for abortions after 14 weeks; both laws are enjoined pending court action.

West Virginia and Wisconsin enacted laws banning abortion at or after 20 weeks post-fertilization (which is equivalent to 22 weeks after the woman’s last menstrual period). The West Virginia measure is in effect; the one in Wisconsin is slated to go into effect in February. Currently, 12 states have similar bans in effect.

4. Targeted Regulation of Abortion Providers (TRAP)

Even as the stage was being set for the U.S. Supreme Court to review TRAP laws, as we reviewed above, legislative action continued apace in several states. Five states adopted TRAP laws in 2015. Following a 2014 ballot initiative that granted lawmakers the ability to enact virtually limitless abortion restrictions, Tennessee enacted a new TRAP law that requires abortion providers to meet the standards that apply to ambulatory surgical centers even though these centers typically provide more invasive and risky procedures than abortion and use higher levels of sedation than commonly provided in abortion clinics.

Arkansas, Indiana, Ohio, and Oklahoma made existing requirements more stringent.

Family Planning Providers

In the aftermath of the release of a series of deceptively edited sting videos aimed at Planned Parenthood, attempts to defund the organization have flared at both the federal and state levels. By the end of 2015, some 11 states had moved to slash funding either for Planned Parenthood health centers specifically or for any family planning provider that also offers abortion services. A Guttmacher analysis shows that defunding Planned Parenthood could seriously impair women’s access to needed services: In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety-net health centers. In one-fifth of the counties in which they are located, Planned Parenthood sites are the sole safety-net family planning center.

PlannedParenthoodIsCritical

States have targeted a variety of funding streams on which family planning providers rely to fund the breadth of their services and activities, and are likely to continue in this vein in the upcoming 2016 legislative sessions:

Medicaid

Mirroring events in Congress, five states—Alabama, Arkansas, Louisiana, Oklahoma, and Texas—took steps to exclude Planned Parenthood from the Medicaid program in 2015. These efforts were blocked by federal courts in Alabama, Arkansas, and Louisiana; a challenge was just filed in November in Texas. Similar efforts made by Arizona and Indiana in recent years were also rebuffed by federal courts.

Other Family Planning Funding

Following the release of the videos, North Carolina expanded its existing provision blocking state funding of “non-public” family planning providers to explicitly apply to family planning providers that also offer abortion services. (Similar measures to bar funding for family planning providers that offer abortion care were introduced in Illinois, Pennsylvania, and Wisconsin.) In addition, New Hampshire’s Executive Council, an administrative board charged with overseeing large funding streams in the state, excluded Planned Parenthood health centers from receiving federal Title X dollars that flow through the state. (Title X funding that Planned Parenthood receives directly from the federal government is not affected.)

Currently, ten states limit eligibility for family planning funding. Eight of these states—Arizona, Arkansas, Colorado, Indiana, North Carolina, Ohio, Texas, and Wisconsin—prohibit abortion providers from receiving state family planning dollars. Kansas and Oklahoma exclude family planning providers not operated by public entities from eligibility.

Funding for Related Services and Activities

North Carolina and Utah moved to exclude family planning providers from eligibility for funding for related services. Legislation enacted in North Carolina bars family planning providers that offer abortion services from receiving funding for adolescent parenting and teen pregnancy prevention programs. Utah Gov. Gary Herbert (R) directed the state department of health to discontinue any funding for Planned Parenthood health centers, including funding for STI surveillance efforts, STI testing and treatment, and abstinence education; a federal appellate court recently prohibited the state from excluding Planned Parenthood from the funds.

Fetal Tissue Donation and Research

As yet another consequence of the release of the Planned Parenthood sting videos, ten states moved to regulate either the process for fetal tissue donation or biomedical research conducted in the state using fetal tissue resulting from induced abortions. Fetal tissue research has been integral to many of the major medical advances of our age. For example, fetal cell lines were used in the development of the polio vaccine and vaccines for diseases such as measles, mumps, rubella, chickenpox, hepatitis A, and rabies. In short, fetal tissue research has saved and improved the lives of millions of people worldwide.

During the final months of 2015, North Carolina and Arizona moved to regulate fetal tissue donation and research. A law enacted in North Carolina prohibits the sale of fetal tissue for a profit, paralleling federal requirements. Arizona adopted an emergency regulation requiring facilities to report any donation of fetal tissue to the state. Measures related to fetal tissue donation and research were introduced last year in Alabama, California, Michigan, New Jersey, Ohio, New York, and Wisconsin.

Editor’s note: Gwendolyn Rathbun and Zohra Ansari-Thomas also contributed to this analysis.