A new Missouri rule will strip state family planning funds from organizations that provide abortions, including hospitals. But several facilities are choosing to go without the money, instead of providing the state with a letter to certify that they do not offer the procedure.
At issue is a $10.8 million portion of the state’s Medicaid program, which covers pelvic exams, tests for sexually transmitted diseases and family planning services for about 70,000 low-income Missouri women. To prevent violating a federal law that says Medicaid patients must be allowed to choose their own provider, the state is rejecting about $8.3 million annually in federal funds, and paying the difference with money from the state.
“From a monetary perspective, this is a small piece of the Medicaid budget, and it is distributed among a number of providers across the state,” said Jane Drummond, legal counsel for the Missouri Hospital Association. “For any particular provider, they’re not looking at a huge portion of their income coming from this program.”
Under the state-funded program, Missouri’s Department of Social Services requires hospitals and clinics to attest that they do not provide abortions, in order to continue receiving payment for family planning services.
In the aftermath of an activist group's release of videos purporting to show the sale of fetal tissue by Planned Parenthood, Missouri Rep. Robert Ross, R-Yukon attempted to cut additional funding from the organization. The videos were later discredited. In March of 2016, Ross sponsored a budget amendment that created the rule to prevent money for women’s health services from going to organizations that provide abortions. The amendment’s language included exceptions for abortions done to save the life of the mother. But hospitals say the state hasn’t put in a mechanism to report pregnancies that are terminated out of necessity.
“Now what happens with the attestation you have filed? It’s not clear," Drummond said. "Obviously the budget language gives us no directive, and the Department of Social Services doesn’t know what its authority is.”
Abortions performed in hospitals are generally done because there is a higher risk of complications, or the woman’s life is in danger. In January, St. Louis Public Radio reported on a local couple who terminated a much-wanted pregnancy at Barnes-Jewish Hospital, after the fetus was diagnosed with a fatal complication.
The MHA is counseling its members to not submit claims to the program after providing an abortion, regardless of the circumstances. A FAQ page also warns that it remains uncertain whether morning-after pills, such as Plan B, are included in the state’s definition of an abortion.
It’s unclear if the rule would survive a legal challenge, said Brigitte Amiri, a staff attorney for the American Civil Liberties Union.
“Many of us are just watching very closely to see how it’s going to be interpreted by the state, and how it’s going to be implemented,” Amiri said. “Once we’re able to see how it’s going to be interpreted, we’ll be able to assess the impact.”
Missouri’s Department of Social Services sent letters to about 500 hospitals and clinics in Missouri and neighboring states, asking them to certify that they do not provide abortions. More than 330 have returned the forms, wrote DSS spokesperson Rebecca Woelfel.
Washington University, which employs physicians at Barnes-Jewish Hospital and other facilities, chose not to attest.
“The new restriction ... will not alter the health-care services provided by Washington University physicians,” wrote Wash U spokeswoman Diane Duke Williams. “We remain committed to providing the full range of reproductive health-care services to our patients, including pregnancy testing, pelvic exams, breast and cervical cancer screenings, and abortion services to address specific therapeutic needs, such as a mother’s health being at risk or for fetal anomalies.”
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