Family Planning

Family planning services provide numerous essential health benefits, including better spacing of pregnancies - leading to healthier outcomes - and fewer unintended pregnancies, abortions and sexually transmitted diseases. In fact, reducing negative health outcomes through the consistent use of effective family planning methods is one goal of Healthy People 2010. (1) States can take several different approaches to promoting access to family planning, and the Report Card examines four such approaches. First, states can require private health insurers to provide contraceptive coverage on the same basis as other prescription drugs. (2) Contraceptives can be expensive, and without insurance coverage, many women are forced to either forgo using contraceptives completely or to use less effective methods. Second, states can facilitate access to emergency contraception (EC). EC provides women with a safe and effective way to prevent unintended pregnancies after unprotected sex or contraceptive failure. (3) Studies show that EC works to prevent pregnancy in the exact same way that ordinary birth control pills do – mainly by preventing ovulation. Given that EC is most effective if used within the first 12 to 24 hours after unprotected intercourse, it is pivotal that women have quick and easy access to it. Third, states can facilitate access to family planning services for low-income women who often face additional barriers to care. Medicaid - the largest public provider of family planning services for low-income women - is unavailable to more than half the low-income women who need these services. (4) Family planning expansion efforts have dramatically increased the number of low-income women served by Medicaid family planning programs. (5) Fourth, states can require private insurers to cover infertility treatments. Between 1995 and 2002, 7.3 million women in the US reported utilizing infertility services. (6) However, private insurance companies do not always cover the costs of treatments, placing them out of financial reach for many families. (7)

  • Contraceptive Coverage

      Strength Of Policy 2007 Change From 2004
    ALABAMA No/Harmful Policy Same
    ALASKA No/Harmful Policy Same
    ARIZONA Meets Policy Same
    ARKANSAS Meets Policy Better
    CALIFORNIA Meets Policy Same
    COLORADO Weak Policy Same
    CONNECTICUT Meets Policy Same
    DELAWARE Meets Policy Same
    DISTRICT OF COLUMBIA No/Harmful Policy Same
    FLORIDA No/Harmful Policy Same
    GEORGIA Meets Policy Same
    HAWAII Meets Policy Same
    IDAHO Weak Policy Better
    ILLINOIS Meets Policy Same
    INDIANA No/Harmful Policy Same
    IOWA Meets Policy Same
    KANSAS No/Harmful Policy Same
    KENTUCKY Weak Policy Same
    LOUISIANA No/Harmful Policy Same
    MAINE Meets Policy Same
    MARYLAND Meets Policy Same
    MASSACHUSETTS Meets Policy Same
    MICHIGAN Meets Policy Better
    MINNESOTA Limited Policy Same
    MISSISSIPPI No/Harmful Policy Same
    MISSOURI Meets Policy Same
    MONTANA Meets Policy Better
    NEBRASKA No/Harmful Policy Same
    NEVADA Meets Policy Same
    NEW HAMPSHIRE Meets Policy Same
    NEW JERSEY Meets Policy Better
    NEW MEXICO Meets Policy Same
    NEW YORK Meets Policy Same
    NORTH CAROLINA Meets Policy Same
    NORTH DAKOTA (1) Limited Policy Same
    OHIO (2) Limited Policy Same
    OKLAHOMA Limited Policy Better
    OREGON (3) Meets Policy Better
    PENNSYLVANIA No/Harmful Policy Same
    RHODE ISLAND Meets Policy Same
    SOUTH CAROLINA No/Harmful Policy Same
    SOUTH DAKOTA No/Harmful Policy Same
    TENNESSEE No/Harmful Policy Same
    TEXAS Weak Policy Same
    UTAH No/Harmful Policy Same
    VERMONT Meets Policy Same
    VIRGINIA Weak Policy Same
    WASHINGTON Meets Policy Same
    WEST VIRGINIA Meets Policy Better
    WISCONSIN Meets Policy Better
    WYOMING (4) Limited Policy Same
     
    Meets PolicyMeets Policy 27  
    Limited PolicyLimited Policy 5  
    Weak PolicyWeak Policy 5  
    No/Harmful PolicyNo/Harmful Policy 14  
    Better Better 9  
    Worse Worse 0  
    Same Same 42  
    • 1. North Dakota was graded incorrectly in the 2004 Report Card. It should have received a "limited policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.
    • 2. Ohio was graded incorrectly in the 2004 Report Card. It should have received a "limited policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.
    • 3. Oregon receives a "meets policy" on the basis of a new law that will go into effect January 1, 2008.
    • 4. Wyoming was graded incorrectly in the 2004 Report Card. It should have received a "limited policy" instead of a "no/harmful policy." Since there is no change in the individual state law for this state, the comparison with 2004 is based on the underlying data, that is, there is no change from 2004.

    Does the state require private insurers that cover prescription drugs to cover all forms of Food and Drug Administration (FDA)-approved prescription contraceptive drugs and devices?

    States receive a "meets policy" if they require private insurance companies that cover prescription drugs to also cover all five FDA-approved forms of contraception.  States receive a "limited policy" if they require only certain types of insurers to cover contraception as they do other prescription drugs.  States receive a "weak policy" if they only require all or some insurers to offer contraceptive coverage as a benefit in employer-sponsored insurance plans, but have not required that it be a mandated benefit in all of these insurance plans.  States receive a "no policy" if they do not require any coverage of contraceptives.
     
     

    Data Source: Contraceptive Coverage, 2006.

    National Women's Law Center, "Contraceptive Equity Laws in Your State: Know Your RightsUse Your Rights," August 2007, available at http://nwlc.org/pdf/ConCovStateGuideAugust2007.pdf Prescription contraceptives include: oral contraceptives, including emergency contraception (the “morning after pill”); injections like Depo Provera and Lunelle; implants like Norplant; intrauterine devices; and barrier methods such as diaphragms and cervical caps. 

  • Access to Emergency Contraception

      Strength Of Policy 2007 Change From 2004
    ALABAMA No/Harmful Policy Same
    ALASKA Weak Policy Same
    ARIZONA No/Harmful Policy Same
    ARKANSAS Weak Policy Better
    CALIFORNIA Meets Policy Same
    COLORADO Weak Policy Better
    CONNECTICUT No/Harmful Policy Same
    DELAWARE No/Harmful Policy Same
    DISTRICT OF COLUMBIA No/Harmful Policy Same
    FLORIDA No/Harmful Policy Same
    GEORGIA No/Harmful Policy Same
    HAWAII Weak Policy Same
    IDAHO No/Harmful Policy Same
    ILLINOIS Weak Policy Same
    INDIANA No/Harmful Policy Same
    IOWA No/Harmful Policy Same
    KANSAS No/Harmful Policy Same
    KENTUCKY No/Harmful Policy Same
    LOUISIANA No/Harmful Policy Same
    MAINE Weak Policy Better
    MARYLAND No/Harmful Policy Same
    MASSACHUSETTS Meets Policy Better
    MICHIGAN No/Harmful Policy Same
    MINNESOTA No/Harmful Policy Same
    MISSISSIPPI No/Harmful Policy Same
    MISSOURI No/Harmful Policy Same
    MONTANA No/Harmful Policy Same
    NEBRASKA No/Harmful Policy Same
    NEVADA No/Harmful Policy Same
    NEW HAMPSHIRE Weak Policy Better
    NEW JERSEY Limited Policy Better
    NEW MEXICO Meets Policy Same
    NEW YORK Limited Policy Same
    NORTH CAROLINA No/Harmful Policy Same
    NORTH DAKOTA No/Harmful Policy Same
    OHIO Limited Policy Better
    OKLAHOMA No/Harmful Policy Same
    OREGON Weak Policy Better
    PENNSYLVANIA No/Harmful Policy Same
    RHODE ISLAND No/Harmful Policy Same
    SOUTH CAROLINA Weak Policy Same
    SOUTH DAKOTA No/Harmful Policy Same
    TENNESSEE No/Harmful Policy Same
    TEXAS Weak Policy Better
    UTAH No/Harmful Policy Same
    VERMONT Weak Policy Better
    VIRGINIA No/Harmful Policy Same
    WASHINGTON Meets Policy Same
    WEST VIRGINIA No/Harmful Policy Same
    WISCONSIN No/Harmful Policy Same
    WYOMING No/Harmful Policy Same
     
    Meets PolicyMeets Policy 4  
    Limited PolicyLimited Policy 3  
    Weak PolicyWeak Policy 11  
    No/Harmful PolicyNo/Harmful Policy 33  
    Better Better 10  
    Worse Worse 0  
    Same Same 41  

    Does the state have a policy that promotes access to emergency contraception?

    A state receives a "meets policy" if it a) requires that women who go to an emergency room after a sexual assault be given information about EC; b) requires that EC be provided upon demand in the emergency room to a woman who has been sexually assaulted; and c) allows pharmacists to dispense EC without a prescription. A state receives a "limited policy" if it has two of the policies and a "weak policy" if it has only one policy.  States with none of the policies receive a "no policy."

    Data Source: Access to Emergency Contraception, 2007.

    Guttmacher Institute, State Policies in Brief, "Emergency Contraception," May 2007, available at http://www.guttmacher.org/statecenter/spibs/spib_EC.pdf.

  • Medicaid Waiver

      Strength Of Policy 2007 Change From 2004
    ALABAMA Meets Policy Same
    ALASKA No/Harmful Policy Same
    ARIZONA Meets Policy Same
    ARKANSAS Meets Policy Same
    CALIFORNIA Meets Policy Same
    COLORADO No/Harmful Policy Worse
    CONNECTICUT No/Harmful Policy Same
    DELAWARE Meets Policy Same
    DISTRICT OF COLUMBIA No/Harmful Policy Same
    FLORIDA Meets Policy Same
    GEORGIA No/Harmful Policy Same
    HAWAII No/Harmful Policy Same
    IDAHO No/Harmful Policy Same
    ILLINOIS Meets Policy Same
    INDIANA No/Harmful Policy Same
    IOWA Meets Policy Better
    KANSAS No/Harmful Policy Same
    KENTUCKY No/Harmful Policy Same
    LOUISIANA Meets Policy Better
    MAINE No/Harmful Policy Same
    MARYLAND Meets Policy Same
    MASSACHUSETTS No/Harmful Policy Same
    MICHIGAN Meets Policy Better
    MINNESOTA Meets Policy Same
    MISSISSIPPI Meets Policy Same
    MISSOURI Meets Policy Same
    MONTANA No/Harmful Policy Same
    NEBRASKA No/Harmful Policy Same
    NEVADA No/Harmful Policy Same
    NEW HAMPSHIRE No/Harmful Policy Same
    NEW JERSEY No/Harmful Policy Same
    NEW MEXICO Meets Policy Same
    NEW YORK Meets Policy Same
    NORTH CAROLINA Meets Policy Same
    NORTH DAKOTA No/Harmful Policy Same
    OHIO No/Harmful Policy Same
    OKLAHOMA Meets Policy Same
    OREGON Meets Policy Same
    PENNSYLVANIA Meets Policy Same
    RHODE ISLAND Meets Policy Same
    SOUTH CAROLINA Meets Policy Same
    SOUTH DAKOTA No/Harmful Policy Same
    TENNESSEE No/Harmful Policy Same
    TEXAS Meets Policy Better
    UTAH No/Harmful Policy Same
    VERMONT No/Harmful Policy Same
    VIRGINIA Meets Policy Same
    WASHINGTON Meets Policy Same
    WEST VIRGINIA No/Harmful Policy Same
    WISCONSIN Meets Policy Same
    WYOMING No/Harmful Policy Same
     
    Meets PolicyMeets Policy 26  
    Limited PolicyLimited Policy 0  
    Weak PolicyWeak Policy 0  
    No/Harmful PolicyNo/Harmful Policy 25  
    Better Better 4  
    Worse Worse 1  
    Same Same 46  

    Has the state applied for and received a Medicaid waiver to expand coverage for family planning services?

    States can expand the pool of low-income women eligible for Medicaid coverage of family planning services by securing a federal Medicaid waiver to broaden the state eligibility requirements for this service only. States that have applied for and received the waiver receive a "meets policy."  States that have neither applied for nor received the waiver receive a "no policy."

    Data Source: Medicaid Family Planning Waiver, 2007.

    Guttmacher Institute, State Policies in Brief, "State Medicaid Family Planninf Eligibility Expansions," May 2007, available at http://www.guttmacher.org/statecenter/spibs/spib_SMFPE.pdf, accessed May 4, 2007. 

  • Infertility Treatment Coverage

      Strength Of Policy 2007 Change From 2004
    ALABAMA No/Harmful Policy Same
    ALASKA No/Harmful Policy Same
    ARIZONA No/Harmful Policy Same
    ARKANSAS Meets Policy Same
    CALIFORNIA Limited Policy Better
    COLORADO No/Harmful Policy Same
    CONNECTICUT Weak Policy Same
    DELAWARE No/Harmful Policy Same
    DISTRICT OF COLUMBIA No/Harmful Policy Same
    FLORIDA No/Harmful Policy Same
    GEORGIA No/Harmful Policy Same
    HAWAII Meets Policy Same
    IDAHO No/Harmful Policy Same
    ILLINOIS Limited Policy Same
    INDIANA No/Harmful Policy Same
    IOWA No/Harmful Policy Same
    KANSAS No/Harmful Policy Same
    KENTUCKY No/Harmful Policy Same
    LOUISIANA Weak Policy Same
    MAINE No/Harmful Policy Same
    MARYLAND Limited Policy Same
    MASSACHUSETTS Meets Policy Same
    MICHIGAN No/Harmful Policy Same
    MINNESOTA No/Harmful Policy Same
    MISSISSIPPI No/Harmful Policy Same
    MISSOURI No/Harmful Policy Same
    MONTANA Limited Policy Same
    NEBRASKA No/Harmful Policy Same
    NEVADA No/Harmful Policy Same
    NEW HAMPSHIRE No/Harmful Policy Same
    NEW JERSEY Limited Policy Same
    NEW MEXICO No/Harmful Policy Same
    NEW YORK Meets Policy Same
    NORTH CAROLINA No/Harmful Policy Same
    NORTH DAKOTA No/Harmful Policy Same
    OHIO Limited Policy Same
    OKLAHOMA No/Harmful Policy Same
    OREGON No/Harmful Policy Same
    PENNSYLVANIA No/Harmful Policy Same
    RHODE ISLAND Meets Policy Same
    SOUTH CAROLINA No/Harmful Policy Same
    SOUTH DAKOTA No/Harmful Policy Same
    TENNESSEE No/Harmful Policy Same
    TEXAS Weak Policy Same
    UTAH No/Harmful Policy Same
    VERMONT No/Harmful Policy Same
    VIRGINIA No/Harmful Policy Same
    WASHINGTON No/Harmful Policy Same
    WEST VIRGINIA Limited Policy Same
    WISCONSIN No/Harmful Policy Same
    WYOMING No/Harmful Policy Same
     
    Meets PolicyMeets Policy 5  
    Limited PolicyLimited Policy 7  
    Weak PolicyWeak Policy 3  
    No/Harmful PolicyNo/Harmful Policy 36  
    Better Better 1  
    Worse Worse 0  
    Same Same 50  

    Does the state require private insurance companies to provide coverage for the diagnosis and treatment of infertility?

    States receive a "meets policy" if they mandate insurance companies to cover some form of infertility treatment.  States receive a "limited policy" if they require only HMOs to cover infertility treatment or if they include a religious restriction.  States that only require insurers to offer coverage of infertility treatments as a benefit in employer-sponsored insurance plans (but have not required that it be mandated in all of these insurance plans) or that allow insurers to refuse to cover infertility treatments for the intended purpose of producing pregnancy receive a "weak policy."  States that do not have any policy regarding infertility treatment receive a "no policy."

    Data Source: Infertility Treatment Coverage, 2006.

    The Henry J. Kaiser Family Foundation, "State Mandated Benefits: Infertility Diagnosis and Treatment, 2006," available at http://www.statehealthfacts.org/comparetable.jsp?ind=492&cat=10. Some state laws mandating insurance coverage of infertility treatment are written broadly and others single out specific treatments. The Report Card does not differentiate among states according to the specific procedures for which they require coverage and considers a state to mandate coverage of infertility treatment in a non-limited way if the state’s mandate applies to all insurance companies.