This piece was co-authored by Nicholas L. Rummell and Vanessa Zapata
Access to healthcare is one major barrier for immigrants and refugees in the United States. Women are acutely vulnerable to experiencing healthcare barriers, especially regarding maternal and reproductive health. Maternal health services are essential in reducing maternal morbidity and mortality. One of the most important aspects of reproductive health related to maternal mortality and poor maternal health outcomes is unintended pregnancies. Studies show that women with unintended pregnancies have lower health status scores, less prenatal care, and higher rates of risky health behavior during pregnancy. These studies consistently show that racial and ethnic minorities are unequally burdened by higher maternal mortality rates.
Many of these deaths are preventable with proper maternal care and appropriate family planning services. However, because of the barriers to healthcare access, many immigrant and refugee community members do not receive family planning healthcare. Family planning plays a significant role in reducing the incidences of infant, child, and maternal morbidity and mortality. It empowers individuals to make informed choices about the timing, spacing, and number of pregnancies and birth, and allows for less physical, emotional, and economic challenges that may arise from unplanned pregnancies.
The Title X Family Planning Program
Given the barriers to accessing healthcare in the United States, the Title X Family Planning Program (Title X) is a critical part of the public health landscape. Title X is a federal grant program that provides funding for family planning and reproductive healthcare services. The program was established in 1970 and is administered by the Office of Population Affairs (OPA) under the United States Department of Health and Human Services (HHS).
Title X grant recipients provide a broad range of family planning services including pregnancy prevention and spacing, pregnancy testing and counseling, and sexually transmitted infection (STI) services. No Title X funding can be used for programs where abortion is a method of family planning. However, Title X can also provide other services like breast and cervical cancer screening, and services for adolescents.
These services are free for individuals whose household income is below 100% of the federal poverty level (FPL). Individuals with a household income below 250% FPL also receive discounts on services on a sliding scale. Unlike many other safety net programs, a key feature of this program is that anyone may receive these services. This means a person, regardless of any characteristic including immigration status, insurance status or income, may walk into a health center that has Title X funding and receive family planning services.
Many individuals, no matter their citizenship status, rely on Title X for necessary family planning care. However, Title X is a relatively small program and health centers receiving title X funding may be difficult to access as the provider network may be sparse depending on the state. Removing the barriers immigrant and refugee women face in accessing contraception will help reduce the risks that unintended pregnancies create. Lawmakers should continue to resist and fight back against any threats to Title X funding and access.
Medicaid expansion and family planning
Another essential policy priority for states should be to strengthen access to family planning services through their Medicaid programs. First, implementing Medicaid expansion in Tennessee would provide TennCare healthcare coverage to thousands of low-income individuals of childbearing age, allowing them access to family planning services. Medicaid expansion would predominantly assist citizens, but some immigrant and refugee community members would also become eligible for TennCare.
Second, Tennessee can join 18 other states and cover family planning services through a Medicaid State Plan Amendment (SPA). The SPA would create a new, limited eligibility group for individuals needing family planning services based solely on income. For eligible participants, the state could provide services regardless of characteristics including immigration status.
Currently, if individuals do get pregnant, in addition to receiving services from health centers with Title X funding, they may also get health insurance through Tennessee’s Children’s Health Insurance Program (CHIP), CoverKids, regardless of immigration status if their household income is below 250% FPL and they reside in Tennessee. For pregnant people enrolled in CoverKids, coverage will last until 60 days postpartum unless otherwise eligible. However, prior to pregnancy, immigrant and refugee women will benefit from access to comprehensive family planning services, which requires Tennessee to maintain a robust Title X program.
The Tennessee Justice Center currently provides assistance to all eligible Tennesseans seeking CoverKids health insurance. To request assistance individuals can call 615-255-0331 or fill out TJC’s case inquiry form here.