Few are using Iowa's family planning program started to thwart Planned Parenthood

Iowa's state-run family planning program has seen a nearly 83% drop in people using its services since it was created in 2017 to exclude abortion providers such as Planned Parenthood from government funding, new state figures show.

The main goal of Iowa's family planning program is to help low- and moderate-income Iowans obtain birth control, routine exams and testing for sexually transmitted infections, along with a variety of other sexual and reproductive health services.

In a controversial move, the Republican-led Iowa Legislature opted to leave behind $3 million annually by discontinuing the state's participation in the federal Medicaid family planning network. Instead, policymakers replaced the program with the current state-run version.

But since it launched in July 2017, the state-run program has served 83% fewer Iowans and has paid for fewer family planning services than it did in previous years.

Department of Health and Human Services Director Kelly Garcia said during a public meeting Thursday that utilization of the family planning program is likely low because very few Iowans are aware of its existence. The state doesn't spend money to advertise or promote the program, so people often stumble across these services by accident, she said.

To better promote the state's family planning program, Garcia said she is having conversations with legislative leaders about possible budget opportunities to promote its services.

“It doesn’t mean you have to spend a ton of money, but you do have to tell people about it in order to have folks find it,” she said during a meeting of the Council on Health and Human Services.

Fewer than 500 Iowans used program services in 2021

The data shows how use of the enrollment has steadily dropped in recent years.

In 2021, 423 Iowans received services under the program, and the average monthly enrollment was 1,267 individuals, according to new figures from the Iowa Department of Health and Human Services.

In 2020, 1,269 individuals used family planning services under the state program, with an average monthly enrollment of slightly more than 2,000 individuals.

In 2017, the year the state created the program, 2,431 people used its services.

By comparison, in 2016, when the state family planning program was still using federal Medicaid money, 4,642 people received services.

Provider participation in the state program has also dropped. In 2020, patients in the program received care from 84 providers. By 2021, the number of providers fell to 25.

Spending has fallen accordingly, with the amount spent on family planning less than one-fourth of what it was before the state made its switch.

In 2016, the cost of services administered was $1.5 million, before falling in 2017 to nearly $837,000. In 2021, the cost for 423 patients under the program was less than $165,000.

Family planning services through Medicaid increase

Iowa lawmakers created the state family planning program in 2017 explicitly to exclude Planned Parenthood and other abortion providers from receiving funding.

Critics argued the move would result in Iowans receiving fewer family planning services, a concern that some say has been confirmed by the latest state figures.

"We have a lot of questions about the data in this report," said Sheena Dooley, spokesperson for Planned Parenthood North Central States. "We are sifting through that right now, but what is clear is that this program continues to falter after being dismantled in 2017 by lawmakers in Iowa."

Proponents of the new program said individuals would be able to access that care elsewhere, including through the Affordable Care Act.

Health and human services agency officials have previously said state data has indicated an uptick in the number of individuals using family planning services through Medicaid, and the latest state data reflects that trend.

Nearly 27,000 individuals used family planning services through Iowa Medicaid in 2021, an increase from roughly 22,000 the year before. An additional 16,500 individuals received services in 2021 through another part of Medicaid, the Iowa Health and Wellness Plan, an increase from nearly 14,600 in 2020.

Shelley Horak, director of early intervention and support at HHS, said in Thursday’s council meeting that state officials do believe individuals may be receiving services through more than one family planning program offered by the state.

For example, people could be using family planning services through both Medicaid and the state-run family planning program, leading to duplication in some of the state’s data.

How much duplication there might be, however, is unclear. Horak said officials can't pull out that data.

However, the new report from HHS this week indicates that individuals who use services under the state family planning program are not otherwise eligible for Medicaid.

When asked by a member of the Council on Health and Human Services about this discrepancy, Horak said expanded eligibility for Medicaid coverage during the pandemic may have allowed Iowans to access these services through Medicaid when they otherwise would not have been able to.

As part of the federal government's emergency response to COVID-19, states were barred from kicking individuals off Medicaid coverage, even if they no longer qualified, until this year. The state is in the process of redetermining Iowans' eligibility and disenrolling those who no longer qualify for coverage.

The latest discussions over the use of the family planning program come as the state agency prepares to boost funding for pregnancy resource centers as part of Republican lawmakers’ recent legislative priorities. Also known as crisis pregnancy centers, these often religiously affiliated organizations offer resources to deter abortion and encourage women to keep their pregnancies or consider adoption.

"While fewer Iowans are able to access care under this program, the state Legislature is putting $1.5 million into funding anti-abortion centers who do not provide any kind of medical care and they are touting them as one of the solutions to the many public health care crises that they've created through their harmful policies," Dooley said.

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: Iowa started a program to cut out Planned Parenthood. Few use it.