Medicaid is the largest public funding source for family planning services in the United States — covering more than 70 million people, including one of five women of reproductive age, more than four of 10 women of reproductive age with low incomes, 4.4 million Black women, 5.7 million Latinas, and 1.4 million Asian American, Native Hawaiian, and Pacific Islander women. In rural areas, nearly one of four women of reproductive age are enrolled. Family planning services, including contraceptive care, are defined as a mandatory benefit in Medicaid, meaning they are statutorily required to be covered.
Reliable access to comprehensive contraceptive services in Medicaid has led to lower rates of unintended pregnancy and improved the health and economic well-being of women and their families. However, on July 4, 2025, President Trump signed into law a budget reconciliation bill (H.R. 1) which will shift Medicaid and threaten contraceptive access for millions of women across the U.S. The impact on key providers of contraceptive care — including Title X family planning centers, federally qualified health centers (FQHCs), rural health centers, and hospitals — could undermine an already underfunded and endangered safety net, further entrenching inequities in contraceptive access for people with low incomes, young people, people of color, and people living in rural areas.
The passage of H.R. 1, in combination with the potential expiration of enhanced premium tax credits at the end of 2025, will leave an estimated 10 million people without health insurance coverage, shifting the landscape of access to contraceptive care across the country. As changes to Medicaid are implemented at the federal level under H.R. 1, states will be forced to make decisions that could further exacerbate the law’s impact.
Under H.R. 1, federal Medicaid cuts amount to approximately $1 trillion, requiring states to reexamine their budgets and revisit decisions about how funding should be allocated within their health care systems. Additionally, the law’s burdensome new requirements may force states to revisit their Medicaid expansion programs. Since 2014, 40 states plus Washington, D.C., have expanded Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level, which is equivalent to $21,597 a year for an individual. These expansions have been associated with an increased use of the most effective, long-acting reversible contraceptive options. As states reexamine their budgets, some may eliminate their expansion programs, which could leave millions more women of reproductive age at risk of losing coverage. More than 62 percent of these women have incomes below the federal poverty level — $15,650 a year for an individual —and over half are between ages 18 and 29.
In addition to Medicaid expansion, many states have Medicaid family planning expansion programs that cover family planning services, including contraceptive care, for people who do not qualify for full Medicaid benefits. States pursue these expansions through Section 1115 waivers and state plan amendments, which are approved by the Centers for Medicare and Medicaid Services. As states look to fill the budget gaps left behind by federal Medicaid cuts, they may consider eliminating their Medicaid family planning expansions. Research shows that every public dollar spent on funding for contraceptive services results in net savings of nearly $6 in public spending. The drastic financial impact of H.R. 1 on state budgets could put these family planning expansions at risk.
It is likely that communities will have fewer access points for contraceptive care. Coverage losses, due to states cutting their expansion populations and other factors, will decrease revenues for FQHCs, Title X health centers, rural hospitals, and other safety-net providers that offer contraceptive services, in addition to primary care and other reproductive health services. With an estimated 42 percent of FQHC revenue coming from Medicaid, reductions in Medicaid spending could limit provider operations or force providers to close their doors. These changes would disproportionately harm people with low incomes, people of color, and people who are uninsured — the communities who rely on safety-net providers the most.
H.R. 1 also includes a provision, currently the subject of litigation, that effectively blocks Planned Parenthood health centers, which serve more than 2 million patients a year, and other critical providers from participating in Medicaid. Many providers are also at risk of losing funding through the Title X Family Planning Program, as the Trump administration withholds Title X funding from grantees and pushes for the elimination of the program. Filling the gap left by Planned Parenthood would require FQHCs and other publicly supported clinics to increase their caseloads by over 100 percent in nine states, and over 80 percent in another three, in a challenging funding environment. Given the mounting financial constraints on many safety-net providers, it’s unlikely they would be able to absorb Planned Parenthood patients, resulting in many losing access to reliable providers for contraceptive services.
The Medicaid provisions passed under H.R. 1 will have a cascading impact that threatens the landscape of vital contraceptive care. This reduction in access will be felt across the country and deepen health inequities. As states plan for H.R. 1’s Medicaid provisions to take effect starting in late 2026, policymakers and advocates should work to protect access to contraceptives by supporting safety-net providers and protecting their family planning expansions.
