Medicaid Rejects My Parents, But Offers Their Kids Birth Control, Sterilization

Kelly Lawyer
By Kelly Lawyer | August 13, 2014 | 5:05 PM EDT

With all of the talk concerning the Affordable Care Act and the future inevitable bankruptcy of Medicaid and Medicare, I have to admit, the conversations had not directly affected myself or my family-until about six months ago.

My family, comprised of my parents, two brothers, and sister, applied for Medicaid at the beginning of the year.  In March, they received a letter from the South Carolina Department of Health and Human Services (SC DHHS) stating their request had been denied because my Dad's income "is more than the policy allows."

My family was fine with this decision and moved on with their lives Medicaid-free - until they received not one, but two letters from SC DHHS-one addressed to my 21 year-old sister and the other to my 19 year-old brother stating they have been approved for "The Family Planning Program."

What is the Family Planning Program you may ask? I asked the same question and, after reading the letter (both letters are identical), what is covered under the Family Planning Program became a bit more clear.

Here is how the letter explained the program:

"This coverage provides family planning services only.  Family planning services include prescriptions, office visits, birth control methods, permanent sterilization procedures (vasectomy and tubal ligation), lab work, examination and counseling related to family planning.  Your coverage does not include treatment for routine side effects or complications associated with family planning methods."

The next questions that came to mind were:

1.      Why do my siblings, both young adults, need "family planning services," yet my parents - who are actually married - do not?

2.      How can someone be denied full Medicaid coverage, but still qualify for any part of the program, if my father's annual income (under which my siblings, because they are still dependents) is too great?

3.      Additionally, does Medicaid cover abortion?

I directed my questions to the Medicaid office for South Carolina.  The operator informed me that the Family Planning Program is part of the Medicaid limited benefits. The operator told me the plan covers contraceptives, yearly gynecologist visits, and permanent sterilization procedures.

In short, the program is an effort to expand Medicaid family planning services to individuals who would otherwise not be eligible for Medicaid.  According to an August 2014 study by the Guttmacher Institute, "29 states have obtained federal approval to extend Medicaid eligibility for family planning services to individuals who would otherwise not be eligible." Their graphic below explains the expansion:

ype="node" title="Medicaid Chart Family Planning

What the study or another sites neglect to clearly explain is why is there the push for expanding family planning services to individuals and families who can, by Medicaid's own estimation, afford doctor's visits, dentist visits, and additional health care treatments, but cannot afford their own "family planning services."

I then asked the operator if Medicaid covers abortions and she replied "I have no idea."  After additional digging, I discovered that of the 50 states, 15 states' Medicaid programs (Alaska, California, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, Montana, New Jersey, New Mexico, New York, Oregon, Vermont, Washington, and West Virginia) cover abortions (as long as the parties seeking the abortion are residents of the state and have their abortion in the same state) and the remaining states do not.

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