When the state legislatures first convened for their 2007 sessions, it seemed that legislation to mandate HPV vaccination would be on the fast track in many states. In fact, by the end of the first quarter, legislation to mandate HPV vaccination for middle school girls was pending in 25 states. The proposals, however, instead became the focal point for widespread opposition from an unlikely combination of parental rights supporters, vaccine opponents, drug company critics, communities of color and some public health advocates. By the end of the third quarter, with all but nine state legislatures having adjourned for the year, Virginia was the only state to have adopted a mandate. Meanwhile, Arizona and Texas enacted measures explicitly prohibiting an HPV vaccination requirement for school entry.
States were somewhat more willing to address the issue of coverage for the HPV vaccine in private insurance plans, with four states adopting measures. Three of the four laws include a specific age range, with Colorado requiring coverage for girls aged 9-26, New Mexico requiring coverage for girls 9-14 and Illinois requiring coverage up to 18. The provision adopted in Nevada requires coverage as recommended by a "competent authority," such as the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, which has recommended that the vaccine be administered routinely to all girls aged 11-12, and as early as age nine at a doctor's discretion, as well as to adolescents and young women aged 13-26, as part of a "catch-up" campaign (see this article for more information on the role of family planning providers in that effort [12]).
In another set of positive developments, three legislatures moved to direct their states to apply for federal permission, known as a waiver, to expand eligibility for family planning services under Medicaid [13] to women who would otherwise not be eligible. The New Hampshire legislation is the most general, simply instructing the state to apply for an expansion. The Missouri legislation directs the state to move to extend eligibility to women with a family income up to 185% of the federal poverty level. (Missouri already has a more limited waiver to provide coverage for family planning to women for up to a year following a Medicaid-funded delivery.)
Finally, the Virginia legislature adopted the second measure in as many years to expand eligibility for family planning services under Medicaid. Like Missouri, Virginia already extended coverage to women postpartum. In 2006, the legislature directed the state to apply for a waiver to extend eligibility for family planning to individuals with an income up to 133% of poverty, which was the ceiling for Medicaid coverage of pregnancy-related care in the state; that application was filed in May 2007. When the state raised that ceiling this year, the legislature moved to maintain parity between the two levels, directing the state to extend eligibility for family planning to individuals with an income up to 200% of poverty. On September 28, the federal government approved the state's earlier application to extend eligibility to 133% of poverty, bringing the number of states that have income-based Medicaid family planning expansions to 20.
Meanwhile, in contrast to these positive developments, eight states continued funding for organizations that promote "alternatives-to-abortion." These funds are often distributed to groups such as "crisis pregnancy centers," which encourage women to consider adoption instead of abortion, and which have been shown to provide misleading information to women [14]. Five of these states (Arizona, Missouri, Ohio, Oklahoma and Pennsylvania) specifically prohibit funds from being disbursed to organizations that provide abortion services, including referral and counseling. The remaining three states (Louisiana, North Dakota and Texas) specify only that their funds are to be distributed to organizations that promote childbirth and provide pregnancy support services.
For summaries of major state legislative actions so far this year, click here [15].
For a table showing legislation enacted in 2007, click here [16].
For the status of state law and policy on key reproductive health and rights issues, click here [17].