Florida’s Agency for Health Care Administration (aka AHCA) is finishing proposals for the state’s Medicaid overhaul to send to the federal government for approval. Among the contentious provisions is one that allows Medicaid providers to opt-out of providing family planning services on “moral or religious grounds.”

Groups such as Planned Parenthood have questioned the legality of this provision, considering that family planning services are federally mandated.

However, AHCA recently told The Florida Independent in a statement that the agency is invoking a federal provision (42 C.F.R. s. 438.102) that the agency says allows plans to elect “not to provide family planning services due to an objection on moral or religious grounds.”

Judith Selzer, a policy director for Planned Parenthood in Florida, says that Florida’s plan actually excludes more services than the federal provision.

Florida’s Medicaid bill contains a list of required minimum benefits that should be covered by providers. Under the section for “family planning services and supplies” the bill’s sponsor added:

Pursuant to 42 C.F.R. s. 438.102, plans may elect to not provide these services due to an objection on moral or religious grounds, and must notify the agency of that election when submitting a reply to an invitation to negotiate.

The federal provision in questions reads:

(2) Subject to the information requirements of paragraph (b) of this section, an MCO, PIHP, or PAHP that would otherwise be required to provide, reimburse for, or provide coverage of, a counseling or referral service because of the requirement in paragraph (a)(1) of this section is not required to do so if the MCO, PIHP, or PAHP objects to the service on moral or religious grounds. [Emphasis added.]

Selzer points out that the provision allows exclusions specifically for counseling and referral services, not necessarily for all “family planning services and supplies.”

“Recipients will have the opportunity to choose a health plan with full awareness of the plan services including family planning,” AHCA wrote. AHCA said that if a plan elects not to provide family planning services due to a moral or religious objection, “the plan enrollees will have access to these very same services through fee-for-service provision outside of the plan.”

Selzer says that while all these assurances are positive, she fears that requiring a woman to go outside of her provider network to get a service is still a barrier for disadvantaged women.

“When you think about the profile of this very vulnerable population,” she says, “this makes it even less likely that they will get these important services.”

Selzer also says that she would be less skeptical of the intent behind these laws if state officials had shown “a healthy respect for women’s health” this past legislative session. She feels that was not the case.

Planned Parenthood is still drafting its petitions to AHCA and the Centers for Medicare & Medicaid Services to reconsider the opt-out provision.

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