Reproductive Health Services Covered by CHP
CHP covers a full range of reproductive health care including abortion.1
Covered reproductive health services include (but are not limited to):
- Contraception -- including (but not limited to): IUDs, diaphragms, birth control pills, condoms, Depo Provera, and Norplant.
- Emergency Contraception -- “Morning-After Pill”
- Abortion -- CHP covers “medically necessary” abortions,2 the same standard that applies to Medicaid.The determination of “medical necessity” is left entirely to the professional judgment of the provider.3 A provider can reasonably conclude that virtually every medically appropriate abortion meets this standard. 4
- STD diagnosis and treatment
- HIV testing and treatment
- Screening for pregnancy, cervical cancer, breast disease, anemia, pelvic problems, hypertension, etc.
- Prenatal care, labor, and delivery -- CHP members who are pregnant may continue to receive services under CHP. They may also be eligible for PCAP/Medicaid for prenatal, delivery, and postpartum care.
No Gatekeeper: Direct Access to Reproductive Health Services
Adolescents enrolled in CHP have DIRECT ACCESS to reproductive health services, without regard to age.
- This means that CHP members CAN obtain services directly from any provider in their plan. They do not need a referral or authorization from their primary care provider (PCP).
- CHP patients CANNOT access these services from providers who are outside their plan network as they can under Medicaid. CHP members can only obtain covered services from providers in their own plan.
If a plan does not offer comprehensive reproductive health services, its members are still entitled to obtain these services.
In New York State, for example Fidelis Care does not provide comprehensive reproductive health services. Fidelis Care is required to advise plan members who seek these services that they can obtain reproductive health care by contacting the following plans:
In NYC, call HealthFirst at 1-800-905-5445 (English), 1-800-761-5445 (Spanish), 1-800-422-5608 (Russian); in Long Island, Westchester, and Rockland, call Genesis at 1-800-599-2920 Ext. 81; in the rest of New York State, call GHI at 1-800-223-9870.
A minor – an individual under 18 – can give informed consent for family planning services, including (but not limited to): abortion, contraception, STD testing and treatment, HIV testing, prenatal care, and labor and delivery. Parental consent is not required for such services.
Under New York State law, minors are entitled to confidentiality when they obtain reproductive health care. With few exceptions, unless the patient consents, a provider may not disclose a minor’s medical records regarding family planning services – including (but not limited to) abortion, contraception, STD testing and treatment, HIV testing, prenatal care, labor, and delivery. This means that a provider may not discuss these services with a minor’s parent without the patient’s consent.
- Practical Note: In meeting the needs of adolescent patients, many providers find it helpful to anticipate the confidentiality problems that may arise. For example, bills, laboratory results, and other communications with the patient at home may cause unintended breaches of confidentiality. Administrative safeguards, such as obtaining special contact phone numbers or other addresses for minor patients, can minimize these problems.
In 1997, the State of New York enacted legislation to expand health insurance for children and adolescents up to the age of 19 under the state’s Child Health Plus (CHP) insurance program. Among the benefits provided by this plan are comprehensive reproductive health services.
New York Forum For Child Health
To order additional copies please call (212) 822-7393
New York Civil Liberties Union
Reproductive Rights Project
125 Broad Street, 17th Floor, New York, NY 10004
(212) 344-3005 www.nyclu.org
Planned Parenthood Of New York City, Inc.
26 Bleecker Street, New York, NY 10012
(212) 274-7200 www.ppnyc.org
1 CHP provides comprehensive benefits including (but not limited to): “pediatric health promotion visits, …professional services for diagnosis and treatment of sickness and injury and other conditions, …and outpatient surgery.” NYS Department of Health, “Child Health Plus Benefits Package,” revised January, 2000.
2 Abortion is covered as a medically necessary service under inpatient or outpatient care.
3 The Department of Social Services has clarified the requirement of medical necessity with regard to abortion as follows: “the decision to recommend or perform an abortion involves the clinical judgment and personal concern of each physician involved. If in his judgment there is need for the operation, no question is raised and no justification is required after the procedure has been completed.” Letter from C.C. Nukols, Jr., Deputy Commissioner for Medical Program Development, Department of Social Services, to Nancy Brown, February 17, 1972. This policy of leaving the determination of medical necessity to the professional judgment of the provider was upheld in Donovan v. Cuomo, 513 N.Y.S.2d 878 (3d Dept. 1987), app. Denied 523 N.Y.S. 2d 495.
4 The Medicaid program has two relevant definitions. Section 365-a(2) of the Social Services Law defines “medically necessary” as:
Necessary to prevent, diagnose, correct or cure conditions in the person that cause acute suffering, endanger life, result in illness or infirmity, interfere with such person’s capacity for normal activity, or threaten some significant handicap. (emphasis added)
In addition, Section 365-a(5)(b) of the Social Services Law provides for “surgical benefits…where delay in surgical intervention would substantially increase the medical risk associated with such surgical intervention.” It is well documented that, while the risks associated with abortion are extremely low, delay in obtaining an abortion dramatically increases those risks. R. Gold, 'Abortion and Women’s Health' 31. The Alan Guttmacher Institute, New York, 1990.