About the Toolkit
Medi-Cal, California’s Medicaid program, is a cornerstone of reproductive and sexual health in the state. Under federal law, all states must cover certain low-income people, including pregnant women and very low-income parents. In the 37 states like California that have expanded Medicaid under the Affordable Care Act, most previously uninsured, low-income women now have access to full Medicaid benefits. Medi-Cal therefore plays a major role in the financing of reproductive and sexual health care services for millions of low-income women in California. These services include a broad range of family planning services such as long-acting reversible contraceptives (LARCs) and abortion care.
California has also enacted a number of protections that strengthen and expand existing service and access requirements for people seeking family planning services and abortion care. Yet barriers to care and confusion about federal and state requirements continue to prevent some individuals, particularly those enrolled in Medi-Cal managed care plans, from receiving the care they need.
The following materials provide background information on federal and California state law pertaining to access to family planning and abortion services. We have also included tools for advocates and clinics to use in their work. If you have any questions about these materials or about accessing LARCs and abortion care in the Medi-Cal managed care context, please contact Senior Staff Attorneys Amy Chen and Priscilla Huang.
Share Your Story
The National Health Law Program is collecting information about specific stories or examples where Medi-Cal providers and clinics were denied payment for an IUD device or service (insertion or removal), rod implantation, depo provera injection, or outpatient abortion procedure. We are also interested in stories where the patient eventually received the service, drug, or device, but experienced unnecessary delays in care and access. If you have such a story to share, please fill out our story collecting survey, or contact Priscilla Huang ([email protected]) and Amy Chen ([email protected]).
State and Federal Guidance
- Dear State Health Official Letter #16-008, June 14, 2016, Medicaid Family Planning Services and Supplies
California State Guidance
- Medi-Cal Update: Inpatient Services, June 2015, Bulletin 489, Inpatient Claims for Long-Acting Reversible Contraceptives
- All Plan Letter 16-010, September 6, 2016, Medi-Cal Managed Care Health Plan Pharmaceutical Formulary Comparability Requirement
- All plan letter re freedom of choice in abortion
Tools for Advocates and Clinics
- NHeLP Fact Sheet: California’s Medi-Cal Protection of Choice for Family Planning Act
- Sample Complaint Letter on Medi-Cal Managed Care Access to LARCs
- Sample Complaint Letter on Medi-Cal Managed Care Access to Abortion Care
- Health Consumer Alliance Fact Sheet on How Consumers Can Address Quality of Care Concerns
- Health Consumer Alliance Quality of Care Chart
- Intrauterine Devices and Implants: A Guide to Reimbursement, July 2015
- Reproductive Health Care Coverage in Medi-Cal
- California Abortion Coverage in Medi-Cal and Private Insurance
- Internal and External Review in Medi-Cal Managed Care Plans