Judge Delays La. Medicaid Funding Decision; Demand for Health Care in La. Shows Need for Planned Parenthood

September 8, 2015 — A federal judge on Wednesday postponed Louisiana's decision to end Planned Parenthood's Medicaid contracts until Sept. 15 and questioned the reasoning behind the state's actions, Bloomberg News/Los Angeles Times reports (Hasselle/Brubaker Calkins, Bloomberg News/Los Angeles Times, 9/2).

Background

Louisiana Gov. Bobby Jindal (R) recently ordered the state to end its Medicaid contract with Planned Parenthood following the release of misleading videos that depict Planned Parenthood staff discussing fetal tissue donation. The videos were released by an antiabortion-rights group called the Center for Medical Progress. CMP secretly filmed the videos by meeting with Planned Parenthood staff while posing as buyers of fetal tissue.

Planned Parenthood has stated that the videos were heavily edited and that the filmed officials did not conduct any illegal activities. The organization said it does not profit from fetal tissue donations and only receives reimbursement for costs associated with such donations, which is legal. Meanwhile, supporters of Planned Parenthood said the videos are part of a decades-long campaign against the organization.

In August, Planned Parenthood Gulf Coast and three Medicaid beneficiaries filed a lawsuit asking a federal court to issue a temporary restraining order and a permanent injunction against the funding cuts. The two clinics in the state, which do not provide abortion services, said cutting Medicaid funding violates federal law allowing Medicaid beneficiaries to seek care from any qualified Medicaid provider. According to the lawsuit, without Medicaid funding, the Planned Parenthood facilities could have to cut staff and hours, and the Baton Rouge facility might have to close completely (Women's Health Policy Report, 8/26).

The Department of Justice filed a legal brief in support of PPGC, contending the state could not cancel Planned Parenthood's Medicaid contract without showing that the clinics were not adequately performing their services or billing incorrectly. Eliminating the funding "without providing any justification related to (the organization's) qualifications to provide medical services would violate Louisiana's obligations under the Medicaid statute's 'free choice of provider' provision," DOJ said, adding, "States do not have unfettered discretion to determine that a provider is not 'qualified' for purposes of federal Medicaid law" (AP/Modern Healthcare, 9/1).

Hearing Details

On Wednesday, U.S. District Court Judge John DeGravelles questioned whether the state could end Planned Parenthood's Medicaid contracts despite the organization's qualifications as a health care provider. "You're telling me the reason to do it is there is no reason?" he asked a lawyer for the state.

DeGravelles also challenged the accuracy of the state's claim that the 5,200 patients who would lose their health care provider if the Planned Parenthood clinic in Baton Rouge shuts down would be able to access other providers in the area. According to DeGravelles, the state's list of alternative providers included dentists and physicians specializing in dermatology, neither of whom likely would be able to provide reproductive care.

Meanwhile, Planned Parenthood has until Sept. 9 to respond to the state's arguments (Bloomberg News/Los Angeles Times, 9/2).

Health Care Demand in La. Demonstrates Need for Planned Parenthood

In related news, the high demand in Louisiana for testing and treatment for sexually transmitted infections, as well as for other reproductive health care, shows how difficult it would be for other health centers in the state to absorb any patients unable to access Planned Parenthood services if the organization's Medicaid funding is cut, the New York Times reports.

Background

According to CDC, Louisiana ranks first in the country for the rate of gonorrhea, second for chlamydia, and third for both HIV and syphilis. In addition, the state qualifies as a medically underserved area, with a largely low-income population in need of health care services, a high rate of unintended pregnancy, few providers willing to accept Medicaid and a shortage of health care providers.

While the two Planned Parenthood clinics in Louisiana currently do not offer abortion services, they provided nearly 20,000 STI tests, as well as gynecological exams, contraceptive services, screenings for cancer and other health services for around 10,000 patients, most of whom are low-income, in 2014. Nationwide, according to the Government Accountability Office, four of five Planned Parenthood patients in 2012 had incomes at or below 150% of the federal poverty level. Two-thirds of states said it was difficult to make sure there were enough Medicaid health care providers, particularly for obstetrics and gynecology.

Meanwhile, abortion-rights opponents have claimed that any patients displaced by eliminating Planned Parenthood funding could access health care services at other health centers, according to the New York Times.

Stakeholders Discuss Effect of Cutting Medicaid Funding

Stephanie Taylor -- medical director for STI programs at the State Office of Public Health and director of Louisiana State University's STI program -- said the state "is ground zero for [STIs]," adding, "You can't just cut Planned Parenthood off one day and expect everyone across the city to absorb the patients."

Further, Sara Rosenbaum, a professor at George Washington University's School of Public Health and Human Services, said redirecting Planned Parenthood's Medicaid funding to other health centers would be a difficult process. She added that it was an "absurd claim" that other health centers could absorb Planned Parenthood's patients, particularly in the South and Midwest. According to Rosenbaum, health centers under the Affordable Care Act (PL 111-148) "have been just overwhelmed with patients because of the expansion of insurance coverage" and "are scrambling to meet the needs of their patients."

Noel Twilbeck -- CEO at CrescentCare, a health care provider in Louisiana with three clinics -- said, "We're going to try to provide care for anyone who walks in our doors, but there's a huge 'but' there. Planned Parenthood provides medical care, comprehensive services to many women, men and families in our community. We cannot afford to have those resources go away." He added that federally qualified health centers in the state likely already have "lengthy wait period[s] for new appointments."

Separately, Sharon Howard, a health care consultant who worked with the Louisiana Department of Health and Hospitals and former director of family planning at LDHH, said federally qualified health centers, while obligated to provide care for low-income patients, also have to charge for their services, which is "a barrier for some people."

Meanwhile, Raegan Carter, senior official at PPGC, said the organization is continuing to build a larger clinic at its site in New Orleans, which will offer abortion services. "We're planning to be able to double the amount of patients [who] we're able to see to meet the need," she said (Calmes, New York Times, 9/1).

Planned Parenthood Files Lawsuit To Block Ala. Medicaid Cuts

In other related news, Planned Parenthood Southeast in August filed a lawsuit in federal court to block Alabama Gov. Robert Bentley (R)'s decision to cut Medicaid funding for the organization, the AP/Sacramento Bee reports (Chandler, AP/Sacramento Bee, 8/28).

Background

Bentley earlier in August said the state would cut Medicaid funding for Planned Parenthood, following the release of CMP's misleading videos. The Alabama Medicaid Agency gave Planned Parenthood a 15-day notice.

According to Alabama Medicaid records, PPS has received less than $5,000 in state funding over the past two years. Specifically, Medicaid allocated $3,417.58 in the current fiscal year to PPS to cover office visits, contraceptive implants and birth control shots, while it paid $933.79 in 2014 for an office visit, an IUD insertion and injections. The funding was not used for abortion services (Women's Health Policy Report, 8/7).

Lawsuit Details

The American Civil Liberties Union, which is representing PPS in the lawsuit, said PPS' Medicaid contract was illegally terminated (Stein, Reuters, 8/29).

According to the lawsuit, Bentley's decision violates federal Medicaid law that requires Medicaid beneficiaries to be able to choose their health care provider. The lawsuit states that the decision to cut funding penalizes low-income women who access contraceptive services and other preventive health care at PPS clinics. PPS said it would seek a preliminary injunction against the decision last week.

PPS CEO Staci Fox said, "We're in court today because each and every patient, and her ability to make her own deeply personal and private health care decisions, matters" (AP/Sacramento Bee, 8/28).

Meanwhile, Susan Watson, executive director at ACLU of Alabama, said, "The federal government and several courts have made clear that a state cannot kick Planned Parenthood out of its Medicaid program simply because Planned Parenthood provides abortion" (Reuters, 8/29).

Texas Gov. Supports Additional Abortion Restrictions

In August, Texas Gov. Greg Abbott (R) endorsed several laws that would impose additional restrictions on abortion and fetal tissue donation in the state, following CMP's videos, the Texas Tribune reports.

One of the proposals would criminalize "any sale or transaction" of fetal tissue by abortion clinics. According to the Tribune, selling fetal tissue already is illegal, and federal law only permits clinics to receive reimbursement for the costs "associated with the transportation, implantation, processing, preservation, quality control, or storage of" fetal tissue for research. Further, Planned Parenthood has said its clinics in Texas do not have a fetal tissue donation program.

Another proposal would make an abortion procedure called intact dilation and evacuation a felony under state law. The method is already illegal under a 2003 federal law.

Abbott's initiative also would make it illegal for abortion providers to alter abortion procedures to preserve fetal tissue. Federal law already prohibits the use of fetal tissue for research if an abortion procedure was altered or timed differently for the sole purpose of collecting fetal tissue.

Lastly, one of the proposals would cut public funding for Planned Parenthood "at the state and local levels." According to the Tribune, Planned Parenthood already has been cut from the state's primary program for women's health and from state funding for breast and cervical cancer screenings. In addition, any Planned Parenthood clinics that do receive state funding are barred from offering abortion services.

Yvonne Gutierrez, executive director of Planned Parenthood Texas Votes, said, "This thoroughly discredited smear campaign stems from totally false claims made by anti-abortion extremists who are pursuing a political agenda that is far outside the mainstream ... Abbott and the politicians behind these baseless attacks have allied themselves with extremists who are willing to lie, harass women and doctors, and reportedly break the law" (Ura/Walters, Texas Tribune, 8/28).