Every year, on September 26, the international community marks World Contraception Day as an opportunity to raise awareness about the vital role of contraception in adult health and empowerment. Robust research from around the world has demonstrated for decades that access to information and the full range of birth control methods, without infrastructural and interpersonal barriers, contributes uniquely to building a thriving, healthy society in which all people enjoy the benefits of bodily autonomy and economic advancement for themselves and their families. But right now, a staggering one in four reproductive-aged women in Illinois have unmet contraceptive needs – this must change.
When people are unable to access their birth control of choice and get this care with respect, we continue to see disparate maternal and infant health outcomes. And in Illinois, Black, Indigenous, and People of Color are more likely than white women to live in a community without a health center that offers patient-centered contraceptive care or to be enrolled in a Medicaid plan with a high penetration of religiously affiliated medical systems that do not offer contraception.
And one of the catalysts to these concerning realities is that many publicly funded health centers in Illinois do not provide equitable access, education, or coverage of contraceptive services. To put it another way, healthcare facilities that are funded by American tax dollars are not held accountable for providing quality comprehensive reproductive health care. It’s time to change that and the good news is there are workable solutions.
On August 24th, Governor Pritzker approved SB 967 that ensures enactment of a Family Planning State Plan Amendment (FP SPA) which will enable tens of thousands of individuals to become eligible for coverage of family planning (i.e. pills, IUD, vasectomy, etc.…) and family planning-related services (i.e. cervical cancer, HIV/ STI screening) who otherwise were not covered. Family planning services are covered 90% federally/10% by the state; consequently, as of 2021, 26 other states have family planning SPAs in place. This is an essential next step for Illinois, but Department of Healthcare and Family Services with the Governor’s leadership must go further to ensure that the Family Planning SPA delivers on its promise of expanding coverage to contraceptive care for those most in need.
The FP SPA must be a model SPA, which includes medical presumptive eligibility (MPE), so care is timely. Illinois has MPE coverage upon positive pregnancy verification; thus, providing this coverage for pregnancy prevention is only logical. The SPA must include a Good Cause Exception for individuals who may have other insurance but who may want to apply for family planning coverage independently due to fear of physical or emotional harm. It must also allow for enrolling as an individual regardless of household income for sake of confidentiality. And lastly, there must be flexible auto-enrollment to maximize coverage. For example, if an individual falls out of coverage for the full Medicaid product but can quality for the FP SPA (e.g., after 12 months postpartum or aging out of CHIP); or if the individual applies only for the FP SPA but qualifies for full benefits.
In addition to ensuring the SPA is set up in way that helps the most people, we must see parallel operational improvements to our state’s Medicaid system which is predominated by 5 MCO plans.
Illinois Medicaid must also:
- Require strong access standards and reasonable network coverage for voluntary contraceptive health services;
- Ensure member transparency so Medicaid members are informed of full coverage to all FDA approved contraceptive services by any Medicaid provider, codifying “Freedom of Choice” which is also an accommodation for the high penetration of religiously affiliated health systems in Illinois and;
- Adopt contraceptive access and quality pay-for-performance metrics so health centers with comprehensive provision of quality contraceptive care are rewarded and recognized in the transition to value based care.
Such changes would allow Illinois to serve as a model for states nationwide on how to embed reproductive well-being screening routine in all primary and preventive care visits. By implementing a model Family Planning SPA and encouraging Illinois Medicaid to adopt contract and reporting requirements that will ensure seamless access to high quality contraceptive care for Medicaid members, Illinois can become a state in which every person can decide if, when, and under what circumstances to become pregnant and parent.
Today, far too many Illinoisans face multiple, intersecting barriers to high quality contraceptive services; individuals are prevented from exercising their reproductive autonomy and achieving reproductive well-being, and their communities are unable to achieve optimal health outcomes across the board. World Contraception Day is the ideal opportunity to commit to building a state-wide healthcare system that fully supports the reproductive autonomy of everyone who lives in Illinois; a State Plan Amendment and the proposed state Medicaid reforms are an ideal way to start.