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Initiative to ensure compliance with key provision in the Affordable Care Act requiring most insurance plans to cover contraception at no out-of-pocket cost.
MADISON — Gov. Tony Evers, together with Wisconsin Office of the Commissioner of Insurance (OCI) Commissioner Nathan Houdek, on Oct 30th, announced Wisconsin has been awarded nearly $500,000 in federal funding to evaluate, support, and expand coverage of and access to reproductive and maternal healthcare. Wisconsin is one of 14 states to have been awarded these funds through the Centers for Medicare & Medicaid Services (CMS) Expanding Access to Women’s Health grant program.
“Every Wisconsinite deserves access to the quality, affordable healthcare they need when they need it, and that includes access to reproductive and maternal health services. Thanks to the protections of the ACA, folks in Wisconsin and across our country are guaranteed access to this care with no out-of-pocket costs,” said Gov. Evers. “These federal investments we’re announcing on Oct 30th, will help make sure folks are getting the care they need while building upon our important work to expand access to critical healthcare services, support moms and babies, and address health disparities to build healthier families and communities across our state.”
The Affordable Care Act (ACA), enacted in 2010, provided groundbreaking access to birth control and contraception care for consumers, as most plans are required by the ACA and its related regulations to cover these services with no out-of-pocket costs. The Biden-Harris Administration has continued building upon the landmark ACA by recently proposing a rule that would significantly expand coverage of contraception with no out-of-pocket costs for millions of Americans under the ACA, including over-the-counter contraception without a prescription. If approved, according to the White House, this would be the most significant expansion of contraception coverage under the ACA since 2012. However, contraception coverage—among other key provisions of the ACA such as protections for people with pre-existing conditions, allowing individuals under 26 to remain on their parents’ health plan, and prohibitions on lifetime limits—could be jeopardized by efforts aiming to repeal the ACA.
“I am fighting every way I can to ensure that women in Wisconsin have the freedom to control their bodies and that essential health care is accessible, regardless of where someone lives,” said U.S. Sen. Tammy Baldwin (D-Wisconsin). “I’m proud to bring home this funding that will put reproductive and maternal health care in reach for more Wisconsin women.”
The Evers Administration through OCI will use the funding to conduct an insurer data call and evaluate compliance with the federal contraceptive coverage mandate as required by the ACA. A consumer survey will also be conducted by OCI to provide insight into the personal experiences of individuals accessing contraception. Finally, OCI may utilize remaining funding for a media campaign to enhance consumer awareness of the contraceptive coverage mandate provided by the ACA and individuals’ right to access reproductive healthcare services.
“Access to reproductive healthcare is critical for Wisconsinites in every corner of the state,” said OCI Commissioner Houdek. “We are eager to put these funds to use so we can evaluate health insurer compliance and consumer awareness of contraceptive coverage mandate.”
The federal funding award announced on Oct 30th, is provided through the Centers for Medicare & Medicaid Services’ (CMS) Expanding Access to Women’s Health Grant program, which is focused on addressing disparities in access to reproductive healthcare and maternal health outcomes. The two-year grant period will conclude in September 2026.
OCI will conduct a detailed review of insurer compliance with Public Health Service Act (PHS) Section 2713, the federal contraceptive care coverage requirements under the Affordable Care Act. This requirement applies to most individual, small group, large group, self-insured, and federal employee health plans. Under this requirement, FDA-approved contraceptive methods prescribed by a doctor should be covered by insurance in most cases, including but not limited to:
Insurers must cover contraception without charging a copayment or coinsurance when the contraceptive is provided by an in-network provider. In recent years, other states have conducted reviews of contraceptive coverage patient experiences and found noncompliance by their state’s insurers.
OCI’s goal is to work with a consultant to request data from individual and group health insurers in Wisconsin to evaluate their compliance with the ACA PHS Section 2713 requirements and also conduct a direct-to-consumer survey, which may include providers and pharmacists, to evaluate the experience of individuals on the ground accessing or providing contraceptive care under their insurance.
ADDITIONAL BACKGROUND ON GOV. EVERS’ EFFORTS TO SUPPORT REPRODUCTIVE, MATERNAL, AND INFANT HEALTH
Gov. Evers believes that every Wisconsinite should have access to quality, affordable healthcare, including reproductive healthcare, and has been a champion for expanding access to reproductive healthcare and defending reproductive freedom. On Oct 30th’s announcement builds upon Gov. Evers’ commitment to expand access to reproductive healthcare, including over-the-counter daily contraception and emergency contraception for Wisconsinites on BadgerCare. In his 2024 State of the State address, Gov. Evers directed the Wisconsin Department of Health Services to issue a standing order to ensure BadgerCare Plus members have direct access to over-the-counter emergency contraception, as well as the first daily over-the-counter contraception pill approved by the FDA, known as the Opill. The orders allow BadgerCare Plus members to get over-the-counter emergency and daily contraception from any Wisconsin Medicaid-enrolled pharmacy under their state coverage without a prescription from their doctor and with no out-of-pocket cost to them.
In addition to vetoing every single bill sent to his desk over the last five years that would seek to limit or weaken individual’s reproductive freedoms in Wisconsin, Gov. Evers’ 2019-21 and 2021-23 budget proposals included investments in “Healthy Women, Healthy Babies” initiatives aimed at improving women’s access to preventative care such as cancer screenings, health exams, and STI testing, supporting healthier pregnancies and births, and addressing racial disparities in maternal and child health. Gov. Evers’ 2023-25 budget proposal also invested more than $50 million to support his “Healthy Moms, Healthy Babies” initiative, investing more than $5.6 million for maternal and infant mortality prevention and expanding Medicaid benefits to cover doula services, including childbirth education and emotional and physical support provided during pregnancy, labor, birth, and the postpartum period. These initiatives in each budget also included the governor’s proposal to expand postpartum Medicaid coverage from 60 days to 12 months.
Additionally, Gov. Evers’ 2019-21 and 2021-23 budget proposals included increasing funding for the Women’s Health Block Grant, which is awarded to organizations that provide pregnancy testing, perinatal care coordination and follow-up, cervical cancer screening, sexually transmitted infection prevention, testing, treatment and follow-up, and general health screenings. Both the 2019-21 and 2021-23 budget proposals would have repealed the prohibition on Title V, Title X, and Women’s Health Block Grant funding provided to organizations that offer abortion services or an organization that has an affiliate that offers abortion services. Additionally, the proposals expanded the Title V and Title X definitions of family planning and family planning services to include the provision of nondirective information related to pregnancy termination. Unfortunately, these provisions were removed by Republicans on the Joint Finance Committee (JFC) in both 2019-21 and 2021-23 budget proposals.
Finally, Gov. Evers’ 2019-21 budget proposal included an increased level of funding for the Wisconsin Well Woman Program. This program provides preventative health screening services to low-income women aged 45 to 64, that include mammograms, pap tests, cervical cancer screening, multiple sclerosis testing, and more. Gov. Evers’ 2021-23 budget proposal included $10 million over the biennium for local public health departments (LPHDs), which provide communicable disease surveillance, prevention, and control services to prevent other diseases and hazards, and other services to promote public health. LPHDs are limited to several targeted programs, including the Wisconsin Well Woman Program, the reproductive health program, and more. Unfortunately, this funding was also removed from the final budget by JFC.