DC--Jacqueline Payne

March 4, 2009 Acting Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Attention: CMS-2232-IFC Room 445-G, Hubert H. Humphrey Building 200 Independence Avenue, SW Washington, DC 20201 Re: Comments on the Medicaid Program; State Flexibility for Medicaid Benefit Packages: Delay of Effective Date - File Code CMS-2232-IFC; 42 CFR Part 440 Dear Acting Administrator: On behalf of Planned Parenthood Federation of America (“Planned Parenthood”), I am pleased to have this opportunity to resubmit our comments of March 21, 2008 and highlight our concerns about the State Flexibility for Medicaid Benefit Packages proposed and final rules (“the rule”), published February 22, 2008 at 73 Fed. Reg. 9714 et seq and December 3, 2008 at 73 Fed. Reg. 73694 et seg respectively. A copy of our original comments follows. As the nation’s leading reproductive health care provider, Planned Parenthood is concerned about the negative impact this rule will have on access to family planning services and supplies for Medicaid beneficiaries. Our affiliates operate more than 880 health centers across the county, providing essential family planning and reproductive health care services to millions of women. The vast majority of our patients are low- income, living at or below 150 percent of the federal poverty level, and a significant portion rely on Medicaid to access the reproductive health care services they need. We applaud the Centers for Medicare and Medicaid Services’ (CMS) decision, in the final rule, to preserve the Medicaid free choice of provider protections for family planning services. Unfortunately, we are deeply concerned that this rule continues to undermine other longstanding protections that ensure access to family planning services for all Medicaid beneficiaries. If implemented, the December 3, 2008 final rule will allow states to exclude family planning services from alternative benefits plans, putting millions of women at risk of unintended pregnancy, breast and cervical cancer, and sexually transmitted infections. Family planning is basic primary health care for women. In fact, 75 percent of poor women consider their family planning center as their usual source of health care. Access to family planning services is essential to ensuring that Medicaid coverage is appropriate for women of reproductive age. Since the 1970’s, the Administration and Congress have supported policies that reduce barriers and improve access to family planning. In addition to maintaining the free choice of provider protections under all Medicaid plans, CMS can and must ensure patient access to essential family planning services and supplies, under a Medicaid benchmark or benchmark-equivalent plan, by: (1) Requiring Secretary-approved coverage to include family planning services and supplies, including drugs (§ 440.330(d)). (2) Designating family planning services and supplies, including drugs, as an “appropriate preventive service” required under benchmark-equivalent plans (§440.335). (3) Allowing beneficiaries to remain in traditional Medicaid if a benchmark plan does not cover family planning services and supplies, including drugs (§ 440.330). We urge you to reconsider our comments on the State Flexibility for Medicaid Benefit Packages proposed rule and to make changes to the final rule that will guarantee access to family planning services for all Medicaid-eligible individuals. If Planned Parenthood can be of further assistance to CMS in reconsidering and redrafting the final rule, please do not hesitate to contact me directly at (202) 973-4810. Respectfully submitted, Jacqueline Payne Director of Government Relations Planned Parenthood Federation of America