Missouri GOP fights over Planned Parenthood as billions for Medicaid remain at risk

For years, Missouri Republicans have been trying to block Planned Parenthood from receiving $400,000 or more a year from Medicaid for providing cancer screenings, birth control and sexually-transmitted disease testing for low-income patients.

Their latest attempt could put more than $4 billion for the entire Medicaid program at risk.

After Republicans reached a tenuous agreement last week on banning Medicaid coverage of certain forms of birth control to renew a critical tax on hospitals that provides billions for the program, some hard-right conservatives are insisting on also stopping payments to Planned Parenthood.

The demand puts the General Assembly in danger of not renewing the tax by July 1, the deadline Republican Gov. Mike Parson has set for action before he rolls out staggering budget cuts to keep the health program for low-income Missourians afloat.

Parson was set to announce his plans for the budget on Monday. His office announced a news conference “regarding efforts needed” to renew the tax before cost-saving measures are needed next month.

Parson had said he would call a special session once an agreement was reached. Anticipation mounted last week that an announcement would come Friday, but none did, signaling that the apparent deal hadn’t fully come together, at least not to Parson’s liking. Without legislation action, the hospital tax will expire Sept. 30.

“There’s a consensus on that issue amongst Republicans,” House Budget Chair Cody Smith, a Carthage Republican, said Friday of the birth control coverage ban. “What we are still continuing to work on is the Planned Parenthood piece.”

The focus on Planned Parenthood comes less than a year after the Missouri Supreme Court rejected Republican attempts to block Medicaid dollars from going to the organization through the state budget. Under federal law, Medicaid funds can’t be used to pay for abortions except in limited circumstances. But Republicans want to stop Medicaid for paying for any services provided by the organization.

In 2018 and 2019, lawmakers put language in the Department of Social Services’ annual budget prohibiting payments to abortion providers and their affiliates. The state withheld more than $1 million in payments from Planned Parenthood affiliates, which operate the Missouri’s only abortion clinic in St. Louis in addition to 11 family planning clinics across the state. The providers sued, and judges said lawmakers could not pass that legislation through the state budget.

Sen. Bob Onder, a Lake St. Louis Republican, is spearheading the latest attempt to halt funding. He calls the hospital tax, known as the Federal Reimbursement Allowance or FRA, the best opportunity to stop the flow of dollars.

“The Missouri Supreme Court has made it very clear we can’t do it in the budget, we have to do it in statute,” Onder said. “And the FRA bill renewal is the perfect vehicle by which to do that.”

Smith said lawmakers have been careful to leave the language out of the budget this year. He said he believes it would be legal to include it in the tax renewal bill.

But Missouri would still risk violating federal law, which requires states’ Medicaid programs to cover patients’ treatments at any provider they choose as long as they are considered “qualified” by the federal government.

“Whether it’s blocking access to birth control or trying to ‘defund’ Planned Parenthood — which really means blocking thousands of Medicaid patients from getting essential care like birth control, cancer screenings, and STI testing at Planned Parenthood health centers — these political games at the expense of patients have to stop,” M’Evie Mead, director of Planned Parenthood Advocates in Missouri, said in a statement.

Both the Planned Parenthood fight and the effort to ban coverage of certain contraceptives underscore the degree to which basic legislation, such as the FRA, has become wrapped up in abortion politics. Republican leaders in charge of the state budget have been placed in the precarious position of crafting anti-abortion restrictions they hope won’t violate federal coverage rules.

“It’s my understanding that states cannot pick and choose who gets federal dollars,” Smith said. “I’m hopeful that we can continue to seek a solution that would enable us to not send any taxpayer dollars whatsoever to any abortion providers or their affiliates, and at the same time keep our federal funding intact.”

The federal government requires state Medicaid programs to cover family planning services, and all insurance plans to cover birth control.

Guidelines are less clear on specific forms of contraception for Medicaid recipients, though federal law does specify that recipients of family planning services must be “free from coercion or mental pressure and free to choose the method of family planning to be used.” The Centers for Medicare and Medicaid Services has in the past encouraged states to cover all forms.

The agreement among Republicans would prohibit Medicaid coverage of Plan B and IUDs, among other contraceptives.

Most states cover all FDA-approved forms of contraceptives, according to a 2016 Kaiser Family Foundation survey, while some do not cover emergency ones.

From 2017 to 2020, Missouri’s Medicaid program covered long-acting reversible contraceptives — which includes IUDs and other implanted birth control — for an average of 8,100 women a year.

IUDs and implants made up 16% of the chosen methods last year for roughly 31,000 mostly low-income women who sought contraceptives from the Missouri Family Health Council’s clinics statewide, said director Michelle Trupiano.

“We are witnessing a high-speed, head-on collision between the responsible governance of funding Medicaid and the far-right Republican politics of banning birth control,” House Minority Leader Crystal Quade, a Springfield Democrat, said in a statement. “If extremism wins, it will be devastating for Missouri.”