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...populations cover and to the specific services they provide. Together, these expanded programs provided critical contraceptive services as well as testing for cervical cancer, sexually transmitted diseases and HIV to 1.7 million clients in FY 2001, with 1.3 million served in California alone. ********** In the early years of the joint federal-state Medicaid program, eligibility was limited largely to low-income, single mothers and their children who were receiving welfare. In the 1980s, however, Congress broke the welfare-Medicaid link for pregnancy-related services by first allowing and later requiring states to extend eligibility for Medicaid-covered prenatal, delivery and postpartum care to women with incomes up to 133% of the federal poverty level far above most states' regular Medicaid income-eligibility ceilings. At their option, states could expand eligibility for pregnancy-related services to women with incomes up to 185% of poverty and even beyond.
Over the last decade, several states have built on this history to expand Medicaid eligibility for family planning services as well. Unlike the increases for pregnancy-related care, which are specifically provided for in the federal statute, these expansions require approval--generally referred to as a "waiver"--from the Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicaid.
Medicaid waivers are generally given to allow for research and demonstration efforts that test innovative approaches to Medicaid coverage. As such, they entail a lengthy federal review process and include extensive evaluation components. Waivers are usually granted for five years, although they may be renewed at CMS's option.
Evolving Federal Requirements
Under the Medicaid statute, waivers must be "budget neutral" to the federal government (that is, federal spending under a waiver cannot exceed what federal spending would have been without a waiver), States that have obtained these waivers have successfully argued that the cost of providing family planning services and supplies to individuals under the program pales...
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