The federal Health Care Financing Administration on December 1, 1999, approved California's request to expand Medicaid coverage of family planning services in the state, bringing to 12 the number of states with approved Medicaid expansions (see chart). Most of these states have obtained federal approval to continue coverage for women enrolled in the program whose eligibility otherwise would be terminated. Generally, these are women with income above a state's normal Medicaid eligibility ceiling who are covered only during pregnancy and a 60-day postpartum period. Five states, including California, have now obtained federal approval to expand Medicaid eligibility solely on the basis of income to people who were not previously covered (TGR, Vol. 2, No. 2, April 1999).

Under the California expansion—approved as a five-year research-and-demonstration "waiver" of existing Medicaid rules—the U.S. government and California will share the costs of providing family planning services to both men and women in the state with incomes up to 200% of the federal poverty line. Since 1997, California has used exclusively state funds to expand coverage of family planning services to residents with incomes above the state's regular Medicaid eligibility ceiling of 86%. That effort has enrolled nearly 780,000 individuals since its inception; approximately 5% of the enrollees are men.

Under the California waiver, family planning services are defined to include the provision of Food and Drug Administration-approved contraceptive methods, male and female sterilization, breast and cervical cancer screening, diagnosis and treatment of sexually transmitted diseases, education and counseling services, HIV diagnosis and basic infertility assessment. In addition, the waiver permits health care providers to determine eligibility for the program at the point of service, making it unnecessary for an applicant to have any contact with the state social services agency.