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RESTRICTIVE RELIGIOUS MANAGED CARE PLANS Some religious denominations operate managed care plans. These plans sometimes refuse to provide coverage for contraception, sterilizations, abortions and other services. This refusal to cover basic women's reproductive services creates special problems for poor women, whose insurance coverage is provided through Medicaid managed care. As more and more states steer Medicaid recipients into managed care plans in order to save money, increasing numbers of women are finding themselves unwittingly enrolled in plans that refuse to cover reproductive services or even to provide counseling or referrals. The Alan Guttmacher Institute has reported that in the Balanced Budget Act of 1997, Congress enacted the first so-called "conscience" clause language specific to the Medicaid program. It allows Medicaid managed care plans to refuse to "provide, reimburse for, or provide coverage of a counseling or referral service if the organization objects to the provision of such service on moral or religious grounds." One such Medicaid managed care program, New York's Catholic-sponsored Fidelis Care, does not cover contraceptive services or counseling, sterilizations or abortions. Fidelis enrollees may go outside the Fidelis network and, exercising the state's "free access policy," find doctors or clinics who will accept their Medicaid cards for these services. But, Fidelis will not provide direct referrals for patients to these Medicaid providers. More than 65,000 Medicaid recipients in NYS are now enrolled in this restrictive managed care plan, which has state Department of Health approval to serve the Medicaid population. (To learn more about Fidelis Care, click here to see the separate section on that plan.) The problems for some Medicaid recipients enrolled in such plans were described by a recent NARAL/NY report. Not all Catholic-sponsored managed care plans deny these services to their enrollees. Some have these services provided through third parties. A
Catholics for a Free Choice study
released in September 2000 found: -Some Catholic plans arrange for the portion of the monies they receive from the payers for health services--either employers or the government--that pay for reproductive health services to go through third-party administrators. -Some
Catholic plans arrange for another insurer to handle payment and provisions
of reproductive health services. One group with special expertise in defending the rights of medicaid recipients enrolled in religious managed care plans is the National Health Law Program.
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