JEFFERSON CITY — State lawmakers on Wednesday were preparing for an extraordinary legislative session next week that could determine whether low-income Missouri women continue to have access to certain birth control methods through Medicaid.
At issue is the renewal of the Federal Reimbursement Allowance, a tax on hospitals and other medical providers seen as critical to the state’s Medicaid program. Conservatives blocked renewal of the tax during the Legislature’s regular session, holding out for restrictions on contraceptives and bans on money flowing to abortion providers such as Planned Parenthood.
According to a draft provided Wednesday by staff for Senate appropriations chairman Sen. Dan Hegeman, R-Cosby, it appeared Republicans were moving forward with renewal of the tax — with bans on coverage for certain methods of birth control such as the Plan B pill and intrauterine devices, or IUDs. The draft does not address funding for Planned Parenthood.
Drugs that would not be covered under the draft legislation include levonorgestrel (Plan B), and a second emergency contraceptive, ella. It also restricts intrauterine devices, or IUDs. Those methods prevent pregnancy; the legislation also singles out the abortion pill, which ends a pregnancy.
All of those methods are classified as an “abortifacient drug or device” under the legislation.
“Emergency contraception is not an abortifacient,” said Dr. Colleen McNicholas, chief medical officer of Planned Parenthood of the St. Louis Region and Southwest Missouri. “There is an intentional strategy to conflate the two so that people are confused, and that is really dangerous.”
“Plan B, ella and IUDs are pregnancy prevention methods — not disruptors,” she said.
State Rep. Tracy McCreery, D-Olivette, said that because levonorgestrel is an ingredient used in common birth control methods in addition to Plan B, other forms of contraception could be banned by the legislation.
“You can tell that they didn’t necessarily talk to doctors and people that understand how birth control works,” she said.
McNicholas said contraceptives not containing levonorgestrel could still be available under the bill but said it was “absolutely” a problem that lawmakers were seeking to limit methods.
“The thing that works best for the patient is the thing that they choose,” she said. “And so folks need to have access to all of the contraceptive methods, because everybody’s unique situation is different.”
Kelli Jones, spokeswoman for Gov. Mike Parson, had not confirmed Wednesday that a special session announcement was forthcoming.
House Budget Chairman Cody Smith, R-Carthage, said last week that it was unclear whether restrictions on contraception would jeopardize federal funding for the state’s Medicaid program.
Smith said in an interview Wednesday that he assumed a compromise would address federal compliance.
“I would assume that it would be something that addresses the concerns around abortifacia while maintaining our federal funding,” Smith said.
Senate Minority Leader John Rizzo, D-Independence, has said the push to ban contraceptives could jeopardize the entire Medicaid program because the state wouldn’t be providing a service required by federal law.
“It’s a gamble to mess with” the Federal Reimbursement Allowance, Rizzo said Wednesday, because “I don’t think anybody actually knows” how the changes will affect federal support.
Missouri women whose household modified adjusted gross income is less than 201% of the federal poverty limit can currently access women’s health care through the state of Missouri’s Uninsured Women’s Health Services program, if they meet certain additional criteria.
“Coverage is limited to family planning and testing and treatment of sexually transmitted diseases,” a state guide notes.
Women must be Missouri residents and be between 18 and 55 to qualify. They must be uninsured and without access to employer-based health insurance. They must not qualify for other MoHealthNet services.
According to a 2019 Gallup poll, using birth control was seen as the most accepted personal moral behavior when compared to things such as drinking alcohol, gambling, divorce, gay and lesbian relations, suicide and a host of other behaviors.
The survey found 92% of respondents said birth control was morally acceptable while 6% said it wasn’t.
Ninety-eight percent of Democrats who responded said using birth control was morally acceptable, versus 88% of independents and 91% of Republicans, the survey found.
The next-most broadly accepted behavior was drinking alcohol, with 79% of respondents saying it was morally acceptable versus 19% who said it wasn’t.
Married men and women having an affair was the least accepted among respondents, with only 9% saying it was “morally acceptable.”