A professional medical organization and the Virginia Board of Health are uneasy about language in the proposed budget that they say will essentially eviscerate a newly launched, two-year pilot program that provides low-income women with contraception.

The Virginia section of the American College of Obstetricians and Gynecologists, or ACOG, has written a letter to the governor asking him to veto or amend the language, and last week the state Board of Health unanimously voted to do the same.

The language spilled over from a debate last year in which anti-abortion groups vehemently opposed $6 million in the budget devoted to funding the program, claiming it would “create a multi-million dollar slush fund for Planned Parenthood.”

The pilot program pays for long-acting reversible contraception, or LARCs, a category that includes intrauterine devices and implants, for women who make 250 percent or less of the federal poverty level (about $51,950 for a family of three).

LARCs can last years and are widely considered the safest and most effective form of birth control. According to the Virginia Department of Health, expected outcomes of the program include reduced rates of unintended pregnancies and abortions.

Twelve providers were approved to participate in the program, including the Virginia League for Planned Parenthood, Planned Parenthood South Atlantic, Virginia Commonwealth University and the University of Virginia health systems, among others.

The amendment added to this year’s proposed budget by Sen. Siobhan Dunnavant, R-Henrico, essentially changes the program’s funding to ensure the state is only paying for LARCs, she said.

“The fact of the matter is, the commonwealth is split at least 50/50 pro-life and pro-choice,” Dunnavant said. “Pro-life people do not want their tax dollars going to something that will make it somehow easier for a company like Planned Parenthood to provide abortions.”

Victoria Cobb, president of the Family Foundation, which opposes abortion, said in a statement that Virginia’s anti-abortion movement is “grateful that the General Assembly corrected their error by working toward ensuring that Planned Parenthood is blocked from being the financial beneficiary of this misguided program.”

In an email, Paulette McElwain, CEO of Virginia League for Planned Parenthood, called the proposed amendment “a political ploy that would dismantle the LARC pilot program and block birth control access for Virginians with lower incomes.

“Access to reliable birth control empowers people to lead healthy lives,” she added. “For women who are uninsured, the idea of paying anywhere from $250 to $1,000 to have a device placed is just not feasible.”

The Virginia section of the American College of Obstetricians and Gynecologists has raised concerns that the changes will cause some of the providers to question their ability to stay involved, said Dr. Aaron Goldberg, the section’s chair.

A common misconception is that the program gives the medical groups one lump sum, Goldberg said. That’s not the case — rather, VDH reimburses them for services they’ve already provided.

“Some providers are more efficient and have better access to patients and have the ability to serve more people in need, but the program does not favor any one over the other,” he said.

In its letter, the group raised concerns that the program will serve fewer women under the changes — a concern shared by state officials.

“It’s ultimately likely going to mean we’re going to be able to serve fewer women because the administrative costs of the program will be higher,” said Dr. Vanessa Walker-Harris, director of the Office of Family Health Services with VDH.

Under the changes, VDH would have to purchase the LARCs outright and then distribute them to the participating groups. That requires the department to become a wholesale distributor, which means getting permission from the state Board of Pharmacy and making the necessary changes to its pharmacy.

In addition to those extra administrative costs, the department won’t be able to benefit from device discounts. Right now, providers can work directly with the manufacturers and use direct discount programs to get a competitive price on the LARCs, Walker-Harris said. But that option isn’t available to VDH because the agency is not permitted by law to extend the discounted prices it receives through federal programs to non-state agencies, according to the ACOG letter.

“They’re basically putting up an extremely high number of barriers — letting the program look like it exists while eviscerating the function of it,” said Dr. Holly Puritz, a member of the state Board of Health. “I feel like we’re doing a huge disservice to the women of Virginia when we quietly allow this to happen.”

Alena Yarmosky, a spokeswoman for Gov. Ralph Northam’s office, said in an email that he is in the process of reviewing legislation passed by the General Assembly, including the budget conference report.

Though she did not say whether Northam intends to veto or amend the language around the pilot program, she added that he, “has long advocated for the commonwealth’s LARC pilot program, and he is committed to ensuring access to high-quality, comprehensive and affordable reproductive health care.”

The pilot program started in October and has so far served more than 300 women. Over the next two years, it is expected to serve 7,300 or so, Dr. Norman Oliver, the state health commissioner, told the Virginia Board of Health last week. As of the end of January, eight of the 12 providers had submitted invoices totaling about $225,000, he said.

Sixty-four percent of the women served so far were at 100 percent or below the federal poverty level, Oliver added.

The Virginia League for Planned Parenthood provides same-day insertion and removals of LARCs every day it has a clinician on site, according to the group’s data. In 2017, it provided 2,031 LARCs to Virginia patients, mostly in Richmond but also in Hampton and Virginia Beach.

Dunnavant said the final budget amendment language was altered from what she originally submitted, though she still agrees with the outcome.

“This was not designed for Planned Parenthood to get a big chunk of money from the state,” she said. “This was designed to get as many devices to women who would benefit from them as possible.”

Jeff Caruso, executive director of the Virginia Catholic Conference, which opposes abortion, said the amendment is a step in the right direction, though the group does not support the program in any form.

VDH has allocated $2.2 million to the Virginia League for Planned Parenthood and $445,000 to Planned Parenthood South Atlantic over the two-year program. Because it currently uses a reimbursement model, those entities — along with the 10 other providers — will invoice VDH and be reimbursed up to their allocated amount.

Dunnavant said that by having VDH distribute the devices itself, the state can be certain that every dollar is accounted for and being used solely to purchase the devices.

The state’s free clinics, she argued, should be getting the bulk of the $6 million to provide the devices to low-income women.

“To me, it did not meet our objective if you’re not getting it into the free clinics,” she said. “Pretty much all of that should be going to the free clinics.”