BOISE (AP) — Idaho officials are taking public comments while considering a Medicaid waiver that would require patients to get a referral from a primary physician before they can get family planning services such as birth control, abortions or pregnancy care.

The Idaho Department of Health and Welfare late Wednesday said it will take comments through Oct. 12 on the waiver that’s required when a state wants to deviate from standard Medicaid rules.

State officials say the referral requirement would apply to all Medicaid recipients in the state and lead to better patient outcomes.

“Medicaid participants seeking family planning services frequently seek care outside their primary care practice,” the agency wrote in the 37-page waiver request. “This can lead to disengagement with primary care and a lack of information on their whole health care experience.”

Critics say the waiver is an attempt to prevent women from seeking medical help.

“It’s clearly intended to prevent families from receiving valuable health care treatment by putting unnecessary obstacles in their way,” said Rebecca Schroeder, executive director of Reclaim Idaho, the group behind a Medicaid expansion initiative passed in November.

Voters authorized Medicaid expansion with the initiative that passed with 61% of the vote after years of inaction by the Idaho Legislature. The federal government would pay 90% of the estimated $400 million cost to cover about 90,000 low-income residents.

To qualify, an individual could have a maximum gross monthly income of $1,437. For a family of four, it’s $2,961.

Idaho lawmakers previously added a handful of restrictions to the law, each requiring waivers from the federal government. There are five waivers in all covering four topics.

The U.S. Department of Health and Human Services’ Centers for Medicare and Medicaid Services last month rejected a waiver allowing people who qualify for Medicaid to instead stay on the state’s health insurance exchange.

The federal agency said it couldn’t accept the waiver for a number of reasons, including that Idaho’s application didn’t offer any information supporting a conclusion that the “waiver would not increase the federal deficit.”

Idaho Republican Gov. Brad Little said the waiver request would be resubmitted.

Another waiver with some similarities to the one that was rejected has gone through the public comment process, but the state hasn’t submitted it yet and might not, said Idaho Department of Health and Welfare spokeswoman Niki Forbing-Orr.

Federal officials told the state the waiver might not be needed. However, discussions with federal officials are ongoing, Forbing-Orr said.

A fourth waiver currently out for public comment would require Medicaid recipients to work 20 hours a week. Exceptions include people who are physically or intellectually unable to work, pregnant women, parents of children younger than 18, people over 59 and students.

A fifth waiver not yet out for public comment would allow Medicaid recipients to receive inpatient treatment for mental health and substance abuse disorders at a freestanding psychiatric hospital. Currently, those services are only available in the psychiatric unit of a full-service hospital.

Enrollment for people eligible for Medicaid expansion begins Nov 1, with coverage starting Jan. 1. State officials have said those dates are valid whether the waivers are approved or not.