Planned Parenthood Affiliates of Michigan

Michigan’s Health Care and Family Planning Program

Family planning is a term that gets tossed around quite frequently. But what does it mean?

Family planning prevents unintended pregnancy and reduces the number of abortions, infant mortalities, low birth weight babies and sexually transmitted infections by allowing people to make informed choices about the number, spacing and timing of their pregnancies and helping them maintain their reproductive health.

Family planning is preventive health care and gynecological medical services that include:

General health assessment and complete physical exams.
Pelvic exams and testing (Pap test).
Clinical exams for and education on breast and cervical cancer.
Screening and counseling for sexually transmitted infections (STIs) including HIV.
Counseling on contraception, including abstinence and natural family planning.
Patient education and pre-pregnancy counseling on the dangers of smoking, alcohol, and drug use during pregnancy.
Education on sexual coercion and violence in relationships.

In Michigan, nearly half of all pregnancies are unintended.

Medicaid & Family Planning
Medicaid, using state and federal funds, is the largest source of public health care services and supplies. Over 1.5 million people were enrolled in 2006. Family planning services are a required health service for Medicaid enrollees in qualified health plans. The health plans are required to reimburse other publicly funded family planning clinics, such as Planned Parenthood, for family planning services provided to an enrollee.

Providing family planning services and supplies saves taxpayer money. Every dollar spent on family planning saves an estimated $3 in Medicaid costs for pregnancy related and newborn care. As a result, family planning services and supplies are federally mandated coverage for all Medicaid recipients.

Until recently in Michigan, Medicaid covered family planning only for those from 0-64 percent of the poverty level. Pregnant women up to 185 percent of the poverty level were eligible for prenatal care and delivery under Medicaid, a much costlier program. However, on March 2, 2006, the federal government approved a request from Michigan for a Medicaid waiver allowing the Michigan Department of Community Health to provide family planning services for women women up to 185 percent of the poverty level ages 19 to 44 who do not have health insurance. Janet Olszewski, community health department director, reports that offering family planning services will save the state Medicaid system about $274 million and prevent about 19,400 unintended pregnancies.

According to Michigan’s Medicaid Practitioner Manual, “A visit for family planning should include: eye, ear, nose and throat examination, thyroid palpitation, breast examination (including instruction in self-exam), auscultation of the heart and lungs, pelvic examination (including biannual speculation, speculation, speculum, examination of the vulva, vagina and cervix), a Pap test, CG culture; rectal examination, family planning counseling; and extremities examination”.

The federal Medicaid program, under section 1902 (a) (23) requires family planning to be covered service and allows clients to go to any provider for family planning whether or not they are enrolled in a managed care plan.

Federal Family Planning Program (Title X)
Title X (ten) of the Public Health Service Act is the federally funded family planning program initiated in 1970 by President Nixon. Title X provides reproductive health care services to approximately 4.8 million low-income women each year. Title X covers those up to 250 percent of the federal poverty level. Clinics receiving Title X dollars must offer confidential, comprehensive reproductive health care including:

General health assessments and examinations.
Screening for STIs, HIV, cervical and breast cancer, high blood pressure, anemia, and infertility.
Pregnancy testing and counseling.
Client and community education.
Referrals for medical and/or socioeconomic problems.
Full range of contraceptive methods (pills, IUDs, injections, patches, barrier methods, natural family planning, surgical sterilization and abstinence).

To qualify as a Title X provider the following provisions must be met:

Minimum national standards of care must be met.
Services must be available regardless of age; marital status and clients must be treated confidentially.
All counselors must be trained to encourage minors to abstain from sexual activity and to involve their parents in a decision to seek family planning services.
Health care professionals must be trained on information, outreach and education efforts. Data collection must be done to provide accountability for federal funds.
People must be given a choice of contraceptive methods including natural family planning without coercion.
No Title X funds may be used for abortion services.
Recipients are charged fees based on their ability to pay.
Federal Title X expenditures for contraceptive services have steadily decreased since 1980.

Click here for additional information about the Title X program.

Michigan’s Family Planning Program
The Michigan Family Planning Program has four goals:

Reduce unintended/unwanted pregnancies and infant mortality in Michigan by providing access to comprehensive family planning services.
Reduce preventable infectious disease incidence and mortality, including HIV, STIs, and vaccine-preventable diseases like Hepatitis B.
Prevent unwanted/unintended teen pregnancies by providing family planning services to teens.
Expand the Department’s capacity to assure that the full range of necessary high quality family planning services are accessible and acceptable to all populations.

For information about legislative and judicial authority on the Michigan Family Planning Program visit the Michigan Legislature web site.

Service Delivery
Michigan has an established service delivery system for family planning. Services are
provided to 233,810 Michiganders through 239 publicly funded family planning clinics across the state. The providers include: 112 local health departments, 32 Planned Parenthood affiliates, 30 hospitals, 50 community health centers, and 15 other private nonprofit agencies. The agencies have signed a contract with the state and must follow aforementioned program guidelines.

Targeted Population and Cost
In Michigan, there are 562,410 women in need of publicly funded contraceptive services and supplies. Family planning programs are available to all women and men regardless of income or ability to pay. Clients below 185% of the poverty level are not charged for family planning services. Those whose income falls between 186% and 250% of the poverty level are assessed fees based on their income and family size. Those above 250% of the poverty level are assessed full fees. The program places emphasis on serving teens, with 31% of the users being under the age of 20. According to the Alan Guttmacher Institute, 174,654 women and 5,585 men were served in Michigan in 2004. 112,740 of those users were below 100% of the poverty level.

While the need for services continues to rise, there remains a lack of increase in family planning funding and the FY 2008 Executive Budget cuts family planning and pregnancy prevention funding by $765,900. In this time of severe budget constraints, we are very concerned about the future funding of pregnancy prevention and family planning in our state.

Click here for additional information about Michigan's Family Planning program, including standards and guidelines.

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