I 

110TH CONGRESS 

1ST SESSION H. R. 2523 

To amend title XIX of the Social Security Act to expand access to contraceptive services for women and men under the Medicaid Program, help 

low income women and couples prevent unintended pregnancies and reduce abortion, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 24, 2007 

Mrs. LOWEY (for herself, Ms. DELAURO, Mr. KIRK, and Mr. WAXMAN) introduced the following bill; which was referred to the Committee on Energy 

and Commerce 

A BILL 

To amend title XIX of the Social Security Act to expand 

access to contraceptive services for women and men 

under the Medicaid Program, help low income women 

and couples prevent unintended pregnancies and reduce 

abortion, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Unintended Pregnancy 

5 Reduction Act of 2007’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 


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1 (1) Rates of unintended pregnancy in the 

2 United States increased by nearly 30 percent among 

3 low-income women between 1994 and 2002, and a 

4 low-income woman today is 4 times as likely to have 

5 an unintended pregnancy as her higher income coun6 terpart. 

7 (2) Abortion rates decreased among higher in8 come women but increased among low income 

9 women between 1994 and 2002, and a low income 

10 woman is more than 4 times as likely to have an 

11 abortion as her higher income counterpart. 

12 (3) Contraceptive use reduces a woman’s prob13 ability of having an abortion by 85 percent. 

14 (4) Levels of contraceptive use among low-in15 come women at risk of unintended pregnancy de16 clined significantly between 1994 and 2002, from 92 

17 percent to 86 percent. 

18 (5) Publicly funded contraceptive services have 

19 been shown to prevent 1,300,000 unintended preg20 nancies each year, and in the absence of these serv21 ices the United States abortion rate would likely be 

22 40 percent higher than it is. 

23 (6) By helping couples avoid unintended preg24 nancy, Medicaid-funded contraceptive services are 

25 highly cost-effective, and every public dollar spent on 


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1 family planning saves $3 in the cost of pregnancy2 related care alone. 

3 (7) Federal law requires State Medicaid pro4 grams to cover pregnancy-related care for women 

5 with incomes up to 133 percent of poverty, and 17 

6 States have expanded this coverage to women with 

7 incomes up to 200 percent of poverty. 

8 (8) 18 States have expanded Medicaid coverage 

9 for family planning services to the same level at 

10 which they provide Medicaid funded pregnancy-re11 lated care. 

12 (9) Equalizing the eligibility levels for family 

13 planning and pregnancy-related care nationwide 

14 would maximize the cost-savings to both the Federal 

15 and State Governments. 

16 (10) A woman should have equal access to con17 traceptive services to help prevent an unintended 

18 pregnancy and to pregnancy-related care if she does 

19 become pregnant. 

20 SEC. 3. EXPANSION OF FAMILY PLANNING SERVICES. 

21 (a) COVERAGE AS MANDATORY CATEGORICALLY

22 NEEDY GROUP.— 

23 (1) IN GENERAL.—Section 1902(a)(10)(A)(i) of 

24 the Social Security Act (42 U.S.C. 

25 1396a(a)(10)(A)(i)) is amended— 


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1 (A) in subclause (VI), by striking ‘‘or’’ at 

2 the end; 

3 (B) in subclause (VII), by adding ‘‘or’’ at 

4 the end; and 

5 (C) by adding at the end the following new 

6 subclause: 

7 ‘‘(VIII) who are described in sub8 section (dd) (relating to individuals 

9 who meet the income standards for 

10 pregnant women);’’. 

11 (2) GROUP DESCRIBED.—Section 1902 of the 

12 Social Security Act (42 U.S.C. 1396a) is amended 

13 by adding at the end the following new subsection: 

14 ‘‘(dd)(1) Individuals described in this subsection are 

15 individuals who— 

16 ‘‘(A) meet at least the income eligibility stand17 ards established under the State plan as of January 

18 1, 2007, for pregnant women or such higher income 

19 eligibility standard for such women as the State may 

20 establish; and 

21 ‘‘(B) are not pregnant. 

22 ‘‘(2) At the option of a State, individuals described 

23 in this subsection may include individuals who are deter24 mined to meet the income eligibility standards referred to 

25 in paragraph (1)(A) under the terms and conditions appliVerDate Aug 31 2005 03:02 May 30, 2007 Jkt 059200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2523.IH H2523

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1 cable to making eligibility determinations for medical as2 sistance under this title under a waiver to provide the ben3 efits described in clause (XV) of the matter following sub4 paragraph (G) of section 1902(a)(10) granted to the State 

5 under section 1115 as of January 1, 2007.’’. 

6 (3) LIMITATION ON BENEFITS.—Section 

7 1902(a)(10) of the Social Security Act (42 U.S.C. 

8 1396a(a)(10)) is amended in the matter following 

9 subparagraph (G)— 

10 (A) by striking ‘‘and (XIV)’’ and inserting 

11 ‘‘(XIV)’’; and 

12 (B) by inserting ‘‘, and (XV) the medical 

13 assistance made available to an individual de14 scribed in subsection (dd) who is eligible for 

15 medical assistance only because of subpara16 graph (A)(10)(i)(VIII) shall be limited to family 

17 planning services and supplies described in sec18 tion 1905(a)(4)(C) including medical diagnosis 

19 or treatment services that are provided pur20 suant to a family planning service in a family 

21 planning setting provided during the period in 

22 which such an individual is eligible;’’ after ‘‘cer23 vical cancer’’. 

24 (4) CONFORMING AMENDMENTS.—Section 

25 1905(a) of the Social Security Act (42 U.S.C. 


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1 1396d(a)) is amended in the matter preceding para2 graph (1)— 

3 (A) in clause (xii), by striking ‘‘or’’ at the 

4 end; 

5 (B) in clause (xii), by adding ‘‘or’’ at the 

6 end; and 

7 (C) by inserting after clause (xiii) the fol8 lowing: 

9 ‘‘(xiv) individuals described in section 

10 1902(dd),’’. 

11 (b) PRESUMPTIVE ELIGIBILITY.— 

12 (1) IN GENERAL.—Title XIX of the Social Se13 curity Act (42 U.S.C. 1396 et seq.) is amended by 

14 inserting after section 1920B the following: 

15 ‘‘PRESUMPTIVE ELIGIBILITY FOR FAMILY PLANNING

16 SERVICES

17 ‘‘SEC. 1920C. (a) STATE OPTION.—A State plan ap18 proved under section 1902 may provide for making med19 ical assistance available to an individual described in sec20 tion 1902(dd) (relating to individuals who meet the in21 come eligibility standard for pregnant women in the State) 

22 during a presumptive eligibility period. In the case of an 

23 individual described in section 1902(dd) who is eligible for 

24 medical assistance only because of subparagraph 

25 (A)(10)(i)(VIII), such medical assistance may be limited 

26 to family planning services and supplies described in 


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1 1905(a)(4)(C) and, at the State’s option, medical diag2 nosis or treatment services that are provided in conjunc3 tion with a family planning service in a family planning 

4 setting provided during the period in which such an indi5 vidual is eligible. 

6 ‘‘(b) DEFINITIONS.—For purposes of this section: 

7 ‘‘(1) PRESUMPTIVE ELIGIBILITY PERIOD.—The 

8 term ‘presumptive eligibility period’ means, with re9 spect to an individual described in subsection (a), 

10 the period that— 

11 ‘‘(A) begins with the date on which a 

12 qualified entity determines, on the basis of pre13 liminary information, that the individual is de14 scribed in section 1902(dd); and 

15 ‘‘(B) ends with (and includes) the earlier 

16 of— 

17 ‘‘(i) the day on which a determination 

18 is made with respect to the eligibility of 

19 such individual for services under the State 

20 plan; or 

21 ‘‘(ii) in the case of such an individual 

22 who does not file an application by the last 

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1 tion referred to in subparagraph (A), such 

2 last day. 

3 ‘‘(2) QUALIFIED ENTITY.— 

4 ‘‘(A) IN GENERAL.—Subject to subpara5 graph (B), the term ‘qualified entity’ means 

6 any entity that— 

7 ‘‘(i) is eligible for payments under a 

8 State plan approved under this title; and 

9 ‘‘(ii) is determined by the State agen10 cy to be capable of making determinations 

11 of the type described in paragraph (1)(A). 

12 ‘‘(B) REGULATIONS.—The Secretary may 

13 issue regulations further limiting those entities 

14 that may become qualified entities in order to 

15 prevent fraud and abuse and for other reasons. 

16 ‘‘(C) RULE OF CONSTRUCTION.—Nothing 

17 in this paragraph shall be construed as pre18 venting a State from limiting the classes of en19 tities that may become qualified entities, con20 sistent with any limitations imposed under sub21 paragraph (B). 

22 ‘‘(c) ADMINISTRATION.— 

23 ‘‘(1) IN GENERAL.—The State agency shall pro24 vide qualified entities with— 


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1 ‘‘(A) such forms as are necessary for an 

2 application to be made by an individual de3 scribed in subsection (a) for medical assistance 

4 under the State plan; and 

5 ‘‘(B) information on how to assist such in6 dividuals in completing and filing such forms. 

7 ‘‘(2) NOTIFICATION REQUIREMENTS.—A quali8 fied entity that determines under subsection 

9 (b)(1)(A) that an individual described in subsection 

10 (a) is presumptively eligible for medical assistance 

11 under a State plan shall— 

12 ‘‘(A) notify the State agency of the deter13 mination within 5 working days after the date 

14 on which determination is made; and 

15 ‘‘(B) inform such individual at the time 

16 the determination is made that an application 

17 for medical assistance is required to be made by 

18 not later than the last day of the month fol19 lowing the month during which the determina20 tion is made. 

21 ‘‘(3) APPLICATION FOR MEDICAL ASSIST22 ANCE.—In the case of an individual described in 

23 subsection (a) who is determined by a qualified enti24 ty to be presumptively eligible for medical assistance 

25 under a State plan, the individual shall apply for 


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1 medical assistance by not later than the last day of 

2 the month following the month during which the de3 termination is made. 

4 ‘‘(d) PAYMENT.—Notwithstanding any other provi5 sion of this title, medical assistance that— 

6 ‘‘(1) is furnished to an individual described in 

7 subsection (a)— 

8 ‘‘(A) during a presumptive eligibility pe9 riod; 

10 ‘‘(B) by a entity that is eligible for pay11 ments under the State plan; and 

12 ‘‘(2) is included in the care and services covered 

13 by the State plan, shall be treated as medical assist14 ance provided by such plan for purposes of clause 

15 (4) of the first sentence of section 1905(b).’’. 

16 (2) CONFORMING AMENDMENTS.— 

17 (A) Section 1902(a)(47) of the Social Se18 curity Act (42 U.S.C. 1396a(a)(47)) is amend19 ed by inserting before the semicolon at the end 

20 the following: ‘‘and provide for making medical 

21 assistance available to individuals described in 

22 subsection (a) of section 1920C during a pre23 sumptive eligibility period in accordance with 

24 such section.’’. 


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1 (B) Section 1903(u)(1)(D)(v) of such Act 

2 (42 U.S.C. 1396b(u)(1)(D)(v)) is amended— 

3 (i) by striking ‘‘or for’’ and inserting 

4 ‘‘, for’’; and 

5 (ii) by inserting before the period the 

6 following: ‘‘, or for medical assistance pro7 vided to an individual described in sub8 section (a) of section 1920C during a pre9 sumptive eligibility period under such sec10 tion’’. 

11 SEC. 4. CLARIFICATION OF COVERAGE OF FAMILY PLAN12 NING SERVICES AND SUPPLIES. 

13 Section 1937(b) of the Social Security Act (42 U.S.C. 

14 1396u–7(b)) is amended by adding at the end the fol15 lowing: 

16 ‘‘(5) COVERAGE OF FAMILY PLANNING SERV17 ICES AND SUPPLIES.—Notwithstanding the previous 

18 provisions of this section, a State may not provide 

19 for medical assistance through enrollment of an indi20 vidual with benchmark coverage or benchmark-equiv21 alent coverage under this section unless such cov22 erage includes for any individual described in section 

23 1905(a)(4)(C), medical assistance for family plan24 ning services and supplies in accordance with such 

25 section.’’. 


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1 SEC. 5. EFFECTIVE DATE. 

2 (a) IN GENERAL.—Except as provided in paragraph 

3 (2), the amendments made by this Act take effect on Octo4 ber 1, 2007. 

5 (b) EXTENSION OF EFFECTIVE DATE FOR STATE

6 LAW AMENDMENT.—In the case of a State plan under 

7 title XIX of the Social Security Act (42 U.S.C. 1396 et 

8 seq.) which the Secretary of Health and Human Services 

9 determines requires State legislation in order for the plan 

10 to meet the additional requirements imposed by the 

11 amendments made by this Act, the State plan shall not 

12 be regarded as failing to comply with the requirements of 

13 such title solely on the basis of its failure to meet these 

14 additional requirements before the first day of the first 

15 calendar quarter beginning after the close of the first reg16 ular session of the State legislature that begins after the 

17 date of enactment of this Act. For purposes of the pre18 vious sentence, in the case of a State that has a 2-year 

19 legislative session, each year of the session is considered 

20 to be a separate regular session of the State legislature. 

Æ 


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