During a global pandemic, our priority should be to remove barriers to needed health services, not create them. That is why the state of Missouri seeking to restrict access to highly qualified and experienced providers in its Medicaid family planning program is especially alarming. This promises to put additional strain on the health care safety net across the state, with patients losing access to their trusted providers.
The Extended Women’s Health Services (EWHS) Program is vital for the thousands of Missourians it serves each year, providing low to no-cost birth control, sexually transmitted infection testing and treatment, and cancer screenings to Missourians under 201 percent of the Federal Poverty Level.
However, in the Department of Social Services’ EWHS Program application to the Centers for Medicare & Medicaid Services, language is included that would restrict patients from obtaining health care at the provider of their choice — health care providers that perform or promote abortions, or affiliates with providers who do so, would be prohibited from providing care in the EWHS Program.
Let’s be clear: The EWHS Program does not include health coverage for abortion, nor has it ever, due to limitations set forth in the Hyde Amendment. Restricting providers from participating in the EWHS Program will in no way reduce abortion, and any type of cut to reproductive health services during the COVID-19 pandemic will be devastating to providers, patients, and communities.
Family planning programs like the EWHS Program are typically the gateway to health care, providing an entry point for patients into the broader health care system. In fact, six in 10 women who obtain care at family planning centers describe it as their usual source of medical care, although in many cases it may be their only source of care.
There are already stark racial disparities in reproductive health care. Black Missouri moms are more likely to die in the perinatal period. The maternal mortality risk for Black women is three times higher than the risk for white women. Black women are more likely to die from breast cancer than white women, but early detection can play a role in reducing cancer-related death. Those without continuous health care coverage — like the kind provided by the EWHS Program — are more likely to avoid care because of cost.
Further, patients served under the EWHS Program are typically lower-income, which means they already face barriers when accessing health care. These patients should be able to receive care at the provider of their choice without additional burdens or obstacles, which will only lead to increased wait times for services. The EWHS Program is essential to reducing health disparities in Missouri, but limiting providers will only deepen racial and economic divides.
The need for publicly funded family planning services already outweighs the capacity of the current safety net network. Twenty-two percent of Missouri women of reproductive age are in need of publicly funded reproductive health care (like the kind provided by the EWHS Program), but in some areas of the state, that number is as high as 38 percent. Eliminating qualified and experienced providers from the EWHS Program will create additional access barriers throughout the state.
Especially during a public health crisis, Missouri Family Health Council, Inc., stands in opposition to all restrictions that make reproductive and sexual health care less accessible, weaken the health care safety net, and negatively affect low-income Missourians. The state of Missouri should be increasing access to publicly funded family planning services to meet Missourians’ needs at this moment, rather than restricting it. In order for the reproductive health care safety net to be successful, it must be well funded and include a diverse provider network to meet the needs of those who rely on it for care.
Equitable access to reproductive and sexual healthcare prevents morbidity and mortality, enables adults and adolescents to make reproductive decisions that are best for them and their futures, and allows Missourians to thrive. The state’s efforts to exclude qualified providers from its Medicaid program are out of touch with public needs and should be rejected.
Michelle Trupiano is the executive director of the Missouri Family Health Council, Inc., which provides funding, training, and support to more than 70 reproductive health clinics across the state.