Health

UnityPoint tests ban under family planning law

Low-income patients in quandary as state, health network talk

St. Luke’s Hospital in Cedar Rapid on Monday, May 12, 2014. (Cliff Jette/The Gazette-KCRG TV9)
St. Luke’s Hospital in Cedar Rapid on Monday, May 12, 2014. (Cliff Jette/The Gazette-KCRG TV9)

Iowa’s decision to bar UnityPoint Health, one of the state’s largest medical networks with facilities including St. Luke’s Hospital in Cedar Rapids, from a family planning program means previously covered low-income patients face having to change doctors or pay out of pocket for services like birth control.

Both options can be bad for women’s health, said Mara Gandal-Powers, senior counsel for reproductive rights and health at the National Women’s Law Center in Washington, D.C.

“If you have to pay out of pocket, there’s the major question: ‘Can you afford to pay out of pocket?’” she said. “Then there’s the question of whether you can afford to pay for the (birth control) method that’s right for you. That’s how people end up with an unintended pregnancy if you’re using methods that don’t work for you.”

Changing health care providers can mean the loss of medical history or patient-provider trust, Gandal-Powers added.

Abortion keeps out providers

Earlier this year, the Iowa Legislature created the $3 million Family Planning Program to funnel money to women’s health care clinics that do not perform abortions.

Though even under the previous program no state money was used directly to perform abortions, Iowa rejected federal money that allowed participation by providers — most notably Planned Parenthood — that include abortion among their services.

The new state program helps cover the cost of birth control, pelvic exams, pregnancy tests and some testing and treatment for sexually transmitted diseases for women and men ages 12 through 54 with household incomes up to 300 percent of poverty level.

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The Iowa Department of Human Services has said UnityPoint Health, with hospitals and clinics in Iowa, Illinois and Wisconsin, is not eligible to participate in the program because some providers perform abortions in some situations.

UnityPoint appealed the department’s decision in August, saying the state shouldn’t exclude the bulk of the network’s hospitals and clinics, which do not provide abortions.

“DHS decision to terminate all UPH providers and facilities from the Family Planning Program is overreaching and inconsistent with Iowa Medicaid certification requirements that are specific to each provider and facility,” Deborah Schmudlach, assistant general counsel for the health network, wrote in an Aug. 14 notice of appeal and request for hearing.

Human Services shut down that request with an Aug. 30 response.

“Please be advised that I am unable to approve your Notice of Appeal and Request for Hearing. There is no provision for a hearing for this action within the state-only Family Planning Program in state or federal law,” wrote Harry Rossander, bureau chief of the department’s appeals section.

The Gazette obtained the correspondence through an Open Records request.

Are hospitals separate entities?

Teresa Thoensen, a UnityPoint spokeswoman, said the network continues to negotiate with Human Services and has not decided whether to take further action, such as filing a lawsuit.

“UnityPoint Health believes our interpretation is consistent with the intent of the FPP and the Iowa Medicaid Program definitions, as well as ensures continued access to care for as many individuals as possible,” Thoensen said.

UnityPoint’s argument hinges on facilities within its network having separate tax ID numbers and being treated as separate entities by Medicaid, Thoensen said.

A search of a ProPublica database of nonprofit organizations shows separate tax ID numbers for several UnityPoint facilities, including St. Luke’s, Allen Memorial in Waterloo and Iowa Lutheran in Des Moines.

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The separation between UnityPoint facilities may go farther than tax IDs, said Matthew Dore, who teaches corporate and business law at Drake University Law School in Des Moines.

“My strong suspicion is that UnityPoint has organized each of its hospitals, medical facilities, providers, etc., as separate legal entities — probably corporations,” Dore said. “But the point is that there is more than a tax ID number that separates UnityPoint from these entities — the entities would all be, under the law, separate legal persons.”

Another question is whether UnityPoint Health has the power to tell its hospitals what services to provide — or stop providing, Dore said.

“If UnityPoint is a parent company of these other entities, or otherwise controls them, then a court still might conclude that UnityPoint ‘maintains or operates a facility’ that performs abortions,” Dore said. “It would depend on how the court interprets the phrase ‘maintain or operate.’”

Dore questions how Human Services can offer no appeal options for UnityPoint.

University of Iowa also SHUT out

The University of Iowa Hospitals and Clinics, also excluded from the state Family Planning Program because some providers perform abortions, has not appealed the state decision.

The 811-bed Iowa City hospital received $19,600 from the previous state/federal family planning network last year, spokesman Tom Moore said. The hospital’s total revenue for that year was about $372 million, according to a Board of Regents report.

Planned Parenthood of the Heartland closed four clinics last summer after losing nearly $2 million from the switch to the new program.

UnityPoint still is evaluating the financial impact of losing out on state Family Planning Program coverage, Thoensen said. But fighting the state’s decision to bar the network isn’t about money, she said.

“Continued access to care is a priority for us,” Thoensen said.

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“When possible, the Family Planning Program patients that are transitioning from the network program would like continuity of care, but as of the start of the Family Planning Program, DHS has excluded UnityPoint providers and facilities. Individuals that receive those covered services under the program, they can continue to do so, but they will have to do so out of pocket.”

UnityPoint encourages patients who received coverage under the previous state/federal program to consult with their UnityPoint provider to talk about their options.

Iowa has 80 clinics that provide family planning services through the federal Title X program. Although some of the clinics provide abortions, no Title X money is used for those services. To find a clinic near you, go to: fpcouncil.com/clinic-locator.

l Comments: (319) 339-3157; erin.jordan@thegazette.com

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