What is Medicaid And How Does It Relate to Reproductive Health?

Medicaid is both a federal and state health coverage program that serves certain low-income people. It is not the same program as Medicare, which is a health coverage program for older Americans over 65 and some with certain disabilities. Jamille Fields Allsbrook, Director of Women’s Health and Rights at the Center for American Progress, sits down with us to talk all things Medicaid and how protecting this program can benefit the reproductive health and rights of folks around the U.S.

Medicaid offers a robust benefit package; it covers hospitalization, emergency care, family planning services and supplies, maternity coverage, non-emergency medical transportation, and more. Who exactly is covered under Medicaid varies state by state because of the Affordable Care Act and Medicaid expansion. If you are below 138% of the federal poverty level, you are eligible for Medicaid, but if you are in a state that hasn’t expanded the program, that percentage will vary. Fourteen states still have not expanded Medicaid.

Due to systemic racism and other structural barriers, Medicaid covers a disproportionate number of people of color—particularly Black and Latina women. This program also impacts the U.S. maternal health crisis. Because there is an existing maternal health crisis in the United States, it is important that we do not scale back on funding for Medicaid, reduce eligibility, or attack accessibility.

Under the Medicaid statute, the federal government has certain minimum requirements that states must adopt in order to receive funding. States have the ability to adopt a “waiver,” which allows experimental adaptation of their state-based Medicaid programs. Some states have used their waivers for good (including making the foundation for their state Medicaid program stronger and more effective), whereas some states use Medicaid waivers in order to impose more barriers to the folks who rely on Medicaid to access healthcare (this includes work requirements, cost-sharing, and lockouts). In Texas specifically, a waiver has been approved that would remove requirements to kick out certain family planning providers from being reimbursed though Medicaid.

Medicaid is an entitlement program, which means if you qualify, then you should be able to enroll. The federal government provides states with the funding that is needed based on the specific health demographics of that state. A recent proposal from the Trump / Pence administration would change that to a block grant, or a block amount of money given by the federal government to each state. This limits states that may need extra Medicaid funding because they are experiencing public health crises, or states that may have higher rates of folks enrolled in Medicaid.

Links from this episode

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Transcript

Jennie: Welcome to RePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jenne: So before we started today, I wanted to say thank you to the people who reached out because they liked our new intro and especially to the people who reached out to comment that they were glad I talked about imposter syndrome. I'm glad that people appreciated that it's important to talk about. It's something, like I said, I struggle with all the time, so it's nice to put it out there and hear that other people have the same problems too. Kind of demystifies it and makes it easier for us all to talk about it. So this week I was thinking there's been so much going on, you know right now impeachment was just wrapping up. The Iowa caucus is where I think… the technical term is a shit show… and there's just been so many other things happening. I've been working on a lot at work and had a lot of deadlines right now. So I've just been really stressed. And I know I talked about self-care recently, but this is talking about it to hold myself accountable that I am not taking the time I need to take care of myself. And it happens, you know, everything else gets prioritized and you forget. It's easy to forget to do the things that you need to do to take care of yourself. So you know, I've been good about doing some of those smaller things. I'm still sticking to my new year's resolution of baking more bread. I've been making something every weekend. But I've been really bad this year about meditating and I've just been reading before I go to bed and just so tired that I've not taking the time to meditate, which helps me sleep better. And so I'm in a really bad stretch again of not sleeping. I want to get good about meditating it again. So this is me putting it out there that this is important to my self-care. I know it is and so I need to prioritize it. And for anybody out there who is also not being good about prioritizing themselves, let's do this together, make ourselves at the priority and do what we need to do. One of the things I need is if anybody can recommend a really good meditation app that they enjoy, I would love to hear what is for do you all feel free to reach out on social media. We're @reprosfightback on Twitter and Facebook and reprosfb on Instagram or you can email me at jennie@reprosfightback.com, and I would love to hear what people are doing and what you're loving. Okay, so with that let's turn to this week's episode. I am really excited about this week's episode.

Jennie: We are going to talk about something that has come up in multiple episodes, but we haven't done a deep dive on it yet and that is Medicaid. I'm really excited to have with me Jamille Fields Allsbrook with the Center for American Progress. So with that, let's turn to this week's interview. Hi Jamille, thanks so much for being here.

Jamille: Thank you so much for having me Jennie.

Jennie: I'm really excited to talk about Medicaid today.

Jamillie: Yes, Medicaid. So exciting but so it often gets ignored as not that exciting but I'm happy you all are doing it because it's critically important.

Jennie: Yeah and I think most people are familiar with Medicare and not realize that there is a separate program called Medicaid. So maybe we'll start there. What is Medicaid?

Jamille: Sure. So Medicaid is a health coverage program for certain low income people. It is a both a state and federal program. It’s important to distinguish it from Medicare, which you mentioned more people know about, which is the program for older adults, people or specific people over 65 and uh, certain people with disabilities. But Medicaid, as I mentioned, covers certain low income communities and people. And the reason I say certain is because historically Medicaid has required that you be not just low income below income and have some other category of eligibility. So low income and a person with a qualifying disability, low income and blind, low income and a caretaker of a minor, low income and a child. And I always like to make that distinction because a lot of people think like, oh, all low income people can just get on Medicaid. And that has historically not been true. People probably then we will probably talk about this some, but the ACA sought to remove some of those category requirements. So in some states if you say has expanded Medicaid, it is just you be low income and meet the income eligibility requirements and a certain… some citizenship requirements also.

Jennie: Yeah. So I mean it's really not that simple to be like who's covered because it does kind of vary state by state because of the Affordable Care Act.

Jamille: Yeah. And that's why I also like to tell, you know, remind that it is a state and federal program, which is different. You know, people like you've mentioned may know Medicare more, which is a purely federal program where Medicaid is a state and federal program. Funding comes from the federal government. The funding also comes from the state. Federal government sends certain minimum eligibility requirements are in benefit requirements but states then still have a lot of flexibility, which I know we'll talk about.

Jennie: Yeah, for better and worse. Right. So what is covered under Medicaid? Is it everything? Is it most things?

Jamille: Yeah, sure. So Medicaid does offer a very uh, robust benefit package and it has certain minimum benefit requirements as I mentioned that are all states have to cover. Problem one that's most or very likely interested to the audience here is a covers family planning services and supplies. States can define sort of what that means, but this includes contraceptives and certain screenings, you know cervical cancer screenings, STI screenings, but Medicaid also covers other benefits like maternity coverage covers services that many other health programs might not cover like non-emergency medical transportation. That is exactly what it sounds like. Transportation getting to and from non-emergency healthcare visits. So it's going to be a very robust program and also covers many of your other basic coverage that you would think about, hospitalization, emergency care, et cetera. One thing that is worth noting is not only does Medicaid cover family planning, Medicaid is the largest public funder of family planning services and supplies covering about 75% of all public dollars spent on a family planning and Medicaid also covers 50% of births in this country. So critically important, you know, some of us could call it, you know, a women's health program given the services that covers and the people that are covered, but it's also could be just as quick as a family planning program.

Jennie: Yeah, and I think it's really important. In our last episode we actually talked about black maternal health and access healthcare and abortion restrictions, so kind of together how they are impacting black maternal health. But clearly Medicaid is also really important program in black maternal health.

Jamille: Yes, no, thank you so much for bringing that up. It certainly is, you know, due to systemic racism and other structural barriers, Medicaid covers a disproportionate number of people of color, particularly black and Latina people. And given the fact it covers 50% of births in this country, how the Medicaid program is structured, what benefits at all for the accessibility to it impacts our maternal health crisis. And as you mentioned, black women are three to four times more likely to die from a pregnancy-related complication. Native American women also around three times more likely. So it, you know, defies logic when we talk about some of these restrictions around Medicaid. To think that in the middle of such a public health crisis, we would try to scale back the Medicaid program or change, you know, eligibility or any, uh, anything else related because it is such a lifeline for those communities. And you know, like I said, we're in the middle of a crisis as you all talked about last episode.

Jennie: Absolutely. So the other one you mentioned is the family planning program. So I think that's also another one where it's hard to talk about who's covered because it does kind of vary state by state because some states have really expanded who that population is because they can expand their program beyond the federal minimum. But maybe want to touch a little bit on the family planning part?

Jamille: Yeah, sure. So as I mentioned, Medicaid covers a robust benefit package of family planning within the program. And if you're in a state that has expanded Medicaid then states under the ACA, then the eligibility requirement is very wonky, but it's 133% of the federal poverty level. If you are below that, then you're eligible. Now, if you in a state that has not expanded Medicaid, then it'll vary and it's, you know, as you mentioned, because they vary state by state, it's hard to just give a definitive answer. But some states it might be if you're 50% some states if it's 100% some states if it's, you know, 75% of the federal poverty level, then you'll be eligible. It also means that there are some states who have graciously expanded other limited pathways to be enrolled in Medicaid. So there are some states who have, let's call the family planning waiver… even if you don't qualify for the general Medicaid program, you might just be able to qualify just to be able to access family planning. Similarly, some states have also created a or adopted a narrow pathway to Medicaid if you are pregnant. And back to what we were talking about with the maternal health sort of crisis, one thing that many of us have been advocating for is that if you do qualify for that pregnancy only pathway, that you be able to qualify for the full extent of benefits, which isn't necessarily true and every state and also that you remain eligible past just 60 days, which is the current only requirement that you might be eligible only for about 60 days following giving birth or following the end of the pregnancy. And so, you know, 60 days is nothing as a mother would say. And so, you know, those limited benefit programs like the family planning, like the pregnancy only pathway, a great and great expansion, but it's even better if a state just expands their Medicaid program. Well, it's all but 14 states have done, but we'll keep working on them.

Jennie: Yes. Yeah. 14 states have still not expanded, which is kind of mind boggling to me. Like why wouldn't you want to ensure that your lowest income people have access to comprehensive health care? Like I just, it boggles my mind.

Jamille: Yeah. You know, but they have all the incentives. You know, as I mentioned, you give federal and state funding covers the Medicaid program. If you expand your Medicaid program, then the federal government kicks in even more. It was the federal government will pay 100% of that cost. Now it is, they, we'll pay around 90% of the cost. So, you know, they won’t say why they won’t do it. I have my theories, um, you know, politics perhaps, but it definitely is in the best interests of the citizens of the state if a state were to, to adopt and expand. And because not only does it expand, and I said this before, but just to sort of harbor on the point, not only does it expand like the income eligibility, but also removing those categories, those burdens some, oh, can you be checked in this box and that box? And you know, because it is true that like I'm from Missouri and my great state of Missouri, you know, they're not only do you have to meet like a very low income, uh, requirement that's, you know, like super low. And so you could be low income and still just not, not low income enough or to put it plain as moms will say, not poor enough to qualify. But then you also have to say, well, I am a childless adult so I still don't qualify. You know, I am a struggling student, maybe making only, you know, a small amount of money, but I don't have any children. I don't have any a disability, I don't have any of these other category requirements. So I still don't qualify. And you know, that's not just to pick on Missouri. That's true. And I know those states that didn't expand.

Jennie: Yeah, no, that was particularly striking when I was first looking at the barriers to accessing Medicaid in those states that haven't expanded as similar to you. I'm from Wisconsin who was also decided not to expand, so it hits close to home. Right. Okay. So we touched a real quick on when we talked about the family planning program, the idea of a waiver. So what's a waiver?

Jamille: Yeah, so under the Medicaid statute, states as I mentioned, because the federal government, because it is a federal state program, federal government has certain minimum requirements that states have to adopt in order to receive the federal funding. But the statute does allow states to get what we call a waiver in order to say I want to adapt my program in certain ways and I they can adapt that program in every way and it is supposed to be that's experimental and promotes the Medicaid program, which is promoting health coverage and access to care. But states can submit these waivers and waivers can be a good thing. The states have done some good things with their waivers. You've seen sort of new innovative models to change how you deliver care delivery system. So how care is delivered in the state. You have seen before sort of the ACA states had used the waivers to expand access to people who otherwise might not have met some of those eligibility requirements. But now you also see waivers is not so great ways to also change some of those things around the Medicaid program, including, you know, trying to impose some additional call sharing requirements on people. Some of these requirements people say, oh it's just a minimum amount. But study after study have shown that if you're low income, even a small dollar amount, you might not be able to qualify. Well you might not be able to, to sort of uh, access care. And you also see states trying to do things like imposing onerous work requirements and you know, other things that are contrary to what the Medicaid program is all about.

Jennie: Yeah. So I think we have seen, like you said, kind of this onslaught of negative waivers. So maybe we'll do a little bit of a deep diving explaining what they are. Cause some of them maybe like at first blush you don't understand how they could be prohibitive. And so first you touched on cost sharing too. Maybe we would want to dig a little bit into that and we don't need to go super deep, but yeah.

Jamille: Yeah. So with the Medicaid program, generally cost sharing is like… prohibited in many instances. And so some states though have these waivers in order to be able to impose more costs and basically, and when I say cost sharing, just stepping back a bit, what I mean are things like you're covered for this service, you're covered for your prescription but you have to pay more out of pocket when you go access it. So many of us, you know like if you have private insurance, you probably used to that concept where you go to the doctor's office, you know any doctor's office, they ask for your insurance card and say your copay is $30 or whatever it is. And so that practice has becoming increasing. You see state more and more states trying to shift the cost upon these populations. And the reason, just to be clear, because you know, people think like, oh well I have insurance and I have to make it go pay. So that's not too bad. As I said before, you're the, remember the communities we're talking about, right? The reason why people are enrolled in the Medicaid program is because many of them cannot afford [inaudible]. We had in private insurance or otherwise afford to be able to access health coverage. And so you see things like, especially things like preventive services, so things like just go into your OB GYN, going to get that well woman visit, going to get a STI, HIV screening, those kinds of things that, you know, they're preventive, you go before it's a thing before it's a problem. And so those kinds of services are increasingly subject to people forgoing it. If they have to pay out of pocket costs that they might not be able to afford. So you know, think about the scenario of you're a mother of two. You could either go get you a well woman visit and pay the amount of whatever it is that you have to pay out of pocket or you need to pay your light bill and you know, to keep your kids with light and heat and you know, other things, um, you know, from that's not a decision, you know, is an easy decision there.

Jennie:…pay for your light bill.

Jamille: Exactly. And so that's, you know, sort of the danger of doing something like, you know, sort of pushing more and more costs on to people. The other one that I mentioned was the work requirements.

Jennie: Right. And there's a range of them.

Jamille: Yeah….Well, it is saying that and they all, they varied. But it might say, Oh, in order to receive Medicaid you have to work a certain amount of hours or be looking for a job for a certain amount of hours or you know, be in some sort of training program. And the reason why that can be so dangerous and prohibitive for people is because first of all, the majority of people on Medicaid work. And so there've been some solo studies, so we'll put out including one from our friends at the Center on Budget and Policy Priorities have done analysis. People at the National Health Law Program, have put out great work that talks about like who is impacted if you impose those work requirements. And 60% of the people who would get these work requirements imposed upon them are people who already have a job, they already work and maybe they don't work the hours that will be required on the waiver. But many of them also will have a reason for that. You know, they go about, again, back to the scenario about sort of a, um, a mother who…I'm not a mother, but from what I hear, the cost of childcare is expensive. And so you many my make the decision, it's actually financially better for me to be a home, take care of my children, then to go out in the workforce and, and also not just financial, also it might be better for the children. And so in that kind of scenario, you would be putting a person in a situation to say, well, either, you know, you stay at home with the child or you lose your health coverage, you know, you, you kind of, you know, choose. And in fact, when this attempts were tried in Congress, even a Republican controlled Congress rejected them in 2017 when we saw the ACA repeal, it was the majority of people who would have these work requirements imposed on them were women. And, uh, you know, so, you know, draw that back to what we talked about with access to family planning services and supplies. And who was, who is harmed. It is, you know, again, women, well it's, you know, we used to get in the short end of the stick at this point. But you know, that is sort of again, some of the dangers of something like all work requirement.

Jennie: So beyond work where amateurs also been a slew of lockouts. Do you mind talking a little bit about what those are?

Jamille: Sure. So you also have things where, um, and it relates to, so the work requirements it works is, so some of the, the other sort of dangerous waivers we talked about where if you don't meet sort of whatever the state is requiring of you, so perhaps you don't meet the, didn’t meet the work requirements then not only get kicked out of the program, but also might have a period of time where you can't get back in. And so again, you're talking about people who, you know, need that access to health care and who now you are, you know, are not only taking their coverage, but you're also saying, well, you won't be able to get back in. And in what way is that a benefit for people's health care? In what way is that a better fit for public health where you're saying, well, we know you need this health coverage but we, you just still won't, we still, we're not going to allow you even to get back in because you didn't meet whatever requirements we tried to impose upon you previously. You know, it is, you know, contrary to everything that the Medicaid program is about.

Jennie: Yeah. So for these all seem very much like we're not going to, we just don't want to give you healthcare and we're kind of a keep it as many barriers as possible to ensure people aren't getting it.

Jamille: Yeah, for sure. And I should have started even started at off, uh, and uh, sort of put it as a context that remember this administration came into office saying they were going to repeal the Affordable Care Act and “transform” the Medicaid program in 2017. We saw various failed repeal bills. They'll give me flashbacks, but so many protests, so many, I started keeping my tennis shoes in the office, but that failed -- voters rejected it. Like I said, even a Republican control, conservative leaning, Congress rejected it, and so now what we see are all of those. The things we just talked about, including we haven't even gotten, so try to transform the program to a block grant program. All of those things were in those failed bills, and so now we just see them trying to do the same thing administratively. So you're right. When you say like, oh, it sounds like all these, you're trying to put all these barriers that will take away people health care. That’s exactly what they tried to do, they're just trying to put all these sort of, where they couldn't do is sort of with a, with a sword just cut it all off. Now it's like a chip, chip, chip away, but the result is still the same.

Jennie: This takes me back to so many conversations about what's happening with Roe.

Jamille: Right, exactly. Always. It's the same. Oh, you know what? That's such a good thought. If I hadn't made that sort of mental line, that's why you are who you are, Jennie. But it is very true. It's like we don't like it, so we're going to chip away at it until it basically doesn't exist. That still exists. And so they can say like, oh, it's still there. Like we didn't take away people's health coverage.

Jennie: Yeah. But you did.

Jamille: Exactly.

Jennie: So, okay. Where do you want to go next? Texas, or dig into block grants.

Jamille: Oh, you know, I'll, I'll talk a little bit about, I'll talk about Texas because, uh, because that's also a waiver.

Jennie: Actually, I was, so, uh, this is getting into much more current. So the other ones have been ongoing for the last little while. The Texas waiver and block grants just came up in the last two weeks, which is wild. So let's talk about what happened in Texas.

Jamille: Yeah. So again, back to sort of the same concept we're talking about, about how the, uh, this administration has approved these waivers that basically… if you do what we think you should do, then we will, we'll approve your waiver and you could use federal funding to do it. And a prime example of that is what we've been calling started this Texas waiver. But in short, what they did on the Roe anniversary nonetheless of course was to approve a waiver request that has been out there pending for quite some time. That will allow Texas to remove certain requirements that people get to choose the provider of their choice and allow Texas to remove that sort of wonky provision in order to kick out certain family planning providers. And so that would mean that, and when I say kick out, that would mean that these family planning providers wouldn't be able to receive Medicaid funding if a person comes in. And so you know, think about that again, practically you're a person, you have Medicaid coverage, you decided to go to your local family planning provider because that's where you've always gone to get your OB GYN appointment exactly where you can get an appointment because when in a timely manner, cause we won't even get into the whole sort of like there are some providers who don't want to take Medicaid enrollees because Medicaid doesn't pay that well. But you know, we talk about that but and so many of these family planning providers have been people's lifeline and access to care, access to not only the things we care about, I mean we care about it all but said all the things, reproductive health services and STI screenings and cervical cancer screening, but also just access to your regular visit. You know, many people consider, especially women consider someone like their OB GYN, their primary care provider and don't know the difference. It wasn't till I got in public health honestly that I even understood that, that you know that conceptually the healthcare system tries to put a difference. And so the limit people's choices of provider and to be clear at Texas has done this and tried this experiment before and it's failed. And so Texas back in, I think it was 2013, tried to out Planned Parenthood out of their family planning program. But then the federal government said, well you can't use federal funding to do this. And so what happened a couple of weeks ago was they say, well you can use federal funding to do this and it'll impact, you know, like I said, providers like Planned Parenthood, but also to be clear a range of family planning providers and also the people and the people who rely on them. So most importantly, when Texas did this before you saw, and this was a New England Journal of Medicine study that show that there was a decrease in people accessing long acting reversible contraception, or LARCs, there was a slight uptick in Medicaid coverage. And that sounds like sort of the scientific study. And I'm sure there's numerous anecdotes out there about people like, well, I just couldn't go to my provider anymore and, and people might not understand. So why, and you know, this is kind of, this is why.

Jennie: And so I think it's also really important to note that yes, we're talking about one waiver in one state, but it's like, I'm going to open the flood gates. There's so many other states that I think there's some that are already pending, but there are so many other states who are going to try and do this exact same thing.

Jamille: Well, that's the concern is that it's going to open the flood gates to set this bad precedent that other states will try and think like this is permitted and acceptable. And you know, again, back to, you know, keeping with the same theme, things that they've tried to do in 2017 that didn't work out. Remember the say ACA repeal also we talked about with also prohibited Planned Parenthood from receiving Medicaid funding. And so now it's like that failed people said no. Um, and now we see like, okay, well we're going to do that. On a state by state basis. Now we're going to try to, but states again, the good thing about waivers is that it has to be a state driving this. So for those, you know, people in state, if you get in a state, if you get wind that your state is considering such things, then you know it's the opportunity for people to speak up.

Jennie: Yeah. And I think this is also just another one of those like basics. Like reproductive healthcare is healthcare, right? Like you need to go for these doctor visits and you need to go to people that are going to take your insurance and have appointments. And that is why this is such, could have such a huge effect.

Jamille: Yeah. And I also, that's another reason why I'm glad when you trust. Yeah. It's one reason I'm glad we're doing this conversation here is because do you think about Medicaid has just started this sort of wonky kind of arcane sort of program out here and like let's be very clear, like something like the Texas waiver is an attack on people's bodily autonomy. It is dictating where you can go access services and it is making a statement about the kinds of services they think people should be able to access. Like we're not talking about like, well you're talking about failed claim provides. We're not talking about, oh you know, all providers are talking about a targeted effort to attack those who provide reproductive health services. And that is them making a judgment call about, you know, good or bad about access and reproductive health services. Even though we know people have already made that call that the majority of people do. But unfortunately this was not the biggest Medicaid news in the last two weeks…The administration sent out guidance to state inviting them to apply for, to transform their program into what's considered a block grant. And so stepping back a bit, you know I mentioned that Medicaid is funding by the federal government's funding by the state program, state government, but it's consider what we call an entitlement program, which means that if you are qualify and you're eligible, then you should be able to enroll in the program. And it also means that the federal government provides states with the funding, with the whatever percentage, the agreement, the state and federal government have. They provide them with the funding that is needed in order to cover those people and cover those services that are, that are covered. This is an attempt to change, but back to those to that 2017 sort of bills would have also change the Medicaid program and would have said no longer is it this sort of needs based sort of funded program. And instead we're going to do what is called a block grant, which means we're going to give you a certain amount of money. And that's it. You know, if a public health crisis comes and you need more than amount of money we gave you for that year, you know, you're on your own. And so it is a bad deal for states is a bad deal for the citizens within those states. And when you think about other types of programs so that do this. So Medicaid has a, had things like a waiting list and things. So they might, you might associate with other health programs. This could create something like that and create sort of a people waiting to get on the, uh, get on the program. It also might force states to make hard decisions where a state, you know, might have to decide either we cut eligibility or we cut the certain services offered or scale them back. And so, you know, it's very concerning.

Jennie: Yeah. And I think one of the things that also seemed concerning to me hearing about the way this new block grant proposal was, was that if states didn't spend all the money, they could keep what they had left, which all I could see withsStates being like, oh, we're going to cut services and cut this and now we have this extra money.

Jamille: Yeah, there's something in there that they talk about like being able to “share the savings with the federal government”. And so, but to your point, just the red flag. Yeah, no it is. And the incentives that it gives states is to say like, okay, well if we can save the federal government money, then we get to take a part in cast-sharing. That savings, well it's, you know, on its face might not sound like a bad idea except for the fact of like saved money. How save money by kicking people off the program, saving money by scaling back what the services that are offered, you know, how are you saving money? And the reason why, going back to how we started this conversation about the services that are covered under Medicaid, you know, remember if you kick the ball for the Medicaid program, then you're also limiting many of those people's access to sexual and reproductive health services as well as lots of other things. This just takes me back to the State of the Union where he said, we're going to lift, we lifted 7 million people off of food stamps. Oh my goodness .You know, and it's… the Medicaid program, they can get a bad rap but you know…the robust services that it's offered under the program and because the, in the specific, some of those unique services like transportation, some people fair well under the program and there even has been some data out there about how people who black and Latino people tend to have better health outcomes under the program. And that is because, you know, because all of the benefits and benefits it offers.

Jennie: Yeah. I, it's just getting so frustrating and trying to stay positive is even the right word, but like not get bogged down in the slog of like just discontinue onslaught of proposed changes.

Jamille: Yeah. And I mean, the good thing, and that's all I'll say, it'll positive, but I always feel like every time I go speak somewhere, I'm always like the Debbie-Downer there. So yeah, I can't relate to that at all. So let's on a positive note again, with the block grants, um, and all of these waivers, it requires a state to apply and take action to do it. And so no state has put in place. So did this block grant and you know, if you get again or you get wind in your state of a state considering taking such action, then, you know, as a citizen of that state, it's time for you to engage with your elected officials.

Jennie: Well that leads us perfectly into, I like to, while I do get to be Debbie-Downer all the time and talking about all these terrible things we do get to end with what can people do to fight back. So what actions can people take around some of these issues?

Jamille: So now that we know, you know, how important it is, you know, pay attention to what's going on in your state. Pay attention if your state is seeking to apply for one of these waivers. One thing that is required is that there is an opportunity for public comment, which can also sound very like, you know, arcane and wonky. But it is an opportunity to like literally submit a letter, submit sort of stories, submit things about the what you think could happen if such a waiver or proposal went through and you know, get out. And even before your state sort of takes the, any of those kinds of actions, you know, let your elected officials know that the reproach, reproductive health community cares about these things and what it means to raise means to our community and the benefits that Medicaid offers. And you could start that education. Now you don't have to wait until your state does anything. You can sort of put them on notice to not consider it. Because I will say even, you know, there are just some horrible officials out there, but there's also people who you might get persuaded…of course the ways sort of especially think about like the block grant guidance, the way it's written I does. How persuasive to states, you know you mentioned like oh you could take advantage of shared savings and you know, it's on us to sort of educate them about like that it's not good. It won't won't be good. And also if you have a network of people and a sort of the citizens around you, letting people know why this is important and letting them know like what this means, what this means for reproductive health, what this means for bodily autonomy and like connect those dots for people.

Jennie: I think it's very valuable because a lot of people might not realize sort of the potential impact that these waivers and other proposals could have. I feel like that's particularly true with Medicaid since so many people are just not familiar with it.

Jamille: Yeah, for sure. For sure. And it is true and it's also true that many people, you know, those of us who are like enrolled in private insurance can get sort of this thing. Like it doesn't relate to me. It doesn't apply to me, but one people, we know that people over the course of the life cycle like change that health program. Like I, you know, I can't even say how many times different sort of health insurance I've had and sometimes people, that means people row in and out of the Medicaid program. It also means that we don't want even private insurance looking at things that the state is doing with their health coverage program thinking there are good models.

Jennie: Right. Well Jamille, thank you so much for being here and doing this. It was great to talk to you about Medicaid.

Jamille: Thank you. Thank you so much for having me. I'm so happy you wanted to talk about Medicaid.

Jennie: Thanks for listening everyone. We'll be back in two weeks to talk about the upcoming Supreme Court case, June Medical Services vs. Gee. Looking at the Louisiana case. I hope you enjoyed the interview with Jamille and we'll see you soon. Thanks

Jennie: Thanks for listening everyone. For more information, including show notes from this episode and previous episodes. Please visit usat our website reprosfightback.com. You can also find us on Facebook and Twitter at RePROs Fight Back and on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and please rate and review us on Apple Podcasts. Thanks.

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