State pays millions to bar Medicaid from Planned Parenthood

JEFFERSON CITY, Mo. -- Missouri lawmakers passed a budget last week that spends millions in state money to block Planned Parenthood from accessing federal funding.

The plan puts Missouri alongside at least a dozen other states in a national effort to strip public money from the country's largest abortion provider. The federal government says states don't have the authority to steer Medicaid funding away from Planned Parenthood, and courts have blocked some of those efforts.

But Missouri's budget writers say eliminating federal dollars from women's health programs means federal restrictions no longer apply.

The Legislature rejected more than $8.3 million in federal Medicaid funding the state was slated to receive for family planning, sexually transmitted disease testing and pelvic exams at county health departments, other clinics and Planned Parenthood. They replaced it with money from Missouri's general revenue, leaving the total unchanged at $10.8 million, and stipulated none of it could go to organizations that provide abortions, as Planned Parenthood does.

Government money cannot fund non-emergency abortions, but states are prohibited from otherwise blocking Medicaid dollars from abortion providers for services such as vaccinations and cancer screenings -- a rule the federal government reiterated Tuesday in a letter to state Medicaid directors.

When lawmakers initially proposed blocking Medicaid payments from Planned Parenthood in March, budget staffers estimated less than $400,000 in Medicaid payments go to Missouri's 13 Planned Parenthood clinics for procedures and drugs.

Planned Parenthood serves more than 50,000 patients per year in Missouri, and about 7,000 of them are on Medicaid, said Sarah Felts, a spokeswoman for the organization. Planned Parenthood will continue accepting Medicaid patients "no matter what," she said.

Medicaid patients still can go to county health departments, rural health clinics and federally qualified health centers, said Sen. Kurt Schaefer, the Columbia Republican who chairs the appropriations committee.

"If someone wants to go to Planned Parenthood, they're free to do that," he said. "Taxpayers in Missouri just aren't going to pay for it anymore."

Rep. Stacey Newman, a St. Louis Democrat, said it was reckless for the Legislature to refuse more than $8 million from the federal government "just because we feel like it."

Schaefer pointed to Texas, which cut Planned Parenthood out of the state's Women's Health Program in 2013. Like Missouri, Republican officials chose to fund the program entirely with state money so it would not run afoul of federal law.

Nevertheless, Planned Parenthood in Texas still receives some Medicaid funding from other programs.

Family planning is the easiest public funding stream for lawmakers to target because it's the biggest, said Emily Horne, a legislative associate with Texas Right to Life. Texas lawmakers are looking at cutting Planned Parenthood out of smaller government programs, such as HIV and AIDS testing, she said.

Texas' decision to exclude Planned Parenthood from family planning programs resulted in over 30 percent fewer claims for long-acting and injectable contraceptives among low-income patients using the Women's Health Program, according to a study published in February in the New England Journal of Medicine. The study found claims for short-term hormonal contraceptives did not significantly change.

Texas Republicans have called that study misleading.

Other than Texas and Missouri, Felts said Planned Parenthood isn't aware of any other state declining federal Medicaid funds for women's health programs.

The $27 billion budget goes into effect July 1.