State efforts to expand Medicaid-funded family planning show promise.

The US government provides 90% of the cost of family planning (FP) services to people eligible for Medicaid, while states contribute the rest and set eligibility ceilings. In the past, only families on welfare received Medicaid, but broader eligibility criteria were created to cover low-income pregnant ("expansion") women until 60 days postpartum, and several states received waivers to extend services beyond this limit. Eight states offer expansion women an additional 2-5 years of FP services, one state offers FP services for 2 years to all women losing regular Medicaid, and four states extend FP services to all low-income women not previously covered by Medicaid. In addition, California provides solely state-funded FP services to women and men with incomes below 200% of the poverty level. Some of these approaches pose outreach challenges, and states have adopted different strategies to extend eligibility to the target population. Data on program enrollment indicate that the state efforts have the potential to reach large numbers of women and to support the work of nonprofit FP clinics. The next step, to expand the program to other states, would be facilitated if Congress obviated the need for states to seek an expansion waiver. Rhode Island's program quickly improved birth intervals for women with Medicaid-funded births so that they were virtually identical to those of privately-insured women and prevented 1443 Medicaid-eligible deliveries, saving $14.3 million through a program that cost $5.7 million from 1994 to 1997.