Some New York women receiving Medicaid-paid contraceptives are being told that under a recent state cost-cutting measure they can't get their preferred, brand-name methods unless a generic version "fails first," which could mean bleeding, nausea or pregnancy.
Women's reproductive rights advocates said there is widespread anxiety over the new rule implemented by a team established by Gov. Andrew Cuomo to revamp the state's Medicaid program. The administration says it is working with private health insurers to address the concerns of women who otherwise could not afford birth control.
"We are still getting daily phone calls," said M. Tracey Brooks, CEO of Family Planning Advocates in Albany. "The medical providers are still trying to work it through the (Medicaid) formula... but patients are being asked to wait weeks at a time."
Contraceptives work best when women are comfortable with them, and a change can trigger adverse physical reactions, Brooks said. In addition, telling a woman she must stop using her weekly or monthly contraceptive and instead take a daily pill could lead to a greater chance of forgetting to take the daily dose, which must be done at the same time of day.
The state Health Department "has found some concerns with some plans and we are now working with them to ensure access to contraception for all women" in the state's Medicaid managed care program, state Medicaid Director Jason Helgerson told The Associated Press.
The concern rises from an apparent unintended consequence of the state's Medicaid cost-cutting effort, which has cut billions of dollars in government costs for the federal-state health care program for the poor. Before the state undertook the effort, it had been spending as much as $53 billion annually on a program that was the most expensive and most generous in the nation in terms of optional services for its nearly 5 million residents on Medicaid.
One measure that took effect Oct. 1 required private insurers in the managed care program to use generic prescriptions whenever possible.
Not all participating private insurers cover the once-a-month NuvaRing or weekly patch contraceptives, which would leave some women who receive Medicaid unable to get those devices. Further, the insurers that do offer one or more of the newer contraceptives have denied the doctor-prescribed contraceptive under the directive.
Some women appealed the decision, which is allowed under the state regulations, although the state has no data on how many have done so. Advocacy groups say an unknown number of others have simply accepted it and now are waiting for failure, advocacy groups say.
"The system is working for millions of women, but it is an ongoing process," said Leslie Moran of the New York Health Plan Association, a statewide health insurance industry lobbying group. "The plans, with the state, are constantly updating their policies."
Moran notes, too, that the appeals process is effective. If a woman had previously tried the birth control pill, and it didn't work, she isn't required to try it again.
"It's not like we're asking them to go back, and those appeals are there for a reason," Moran said. "They are there to make sure that people who have individual needs are going to have those needs met. It's a recognition that not everyone is the same."