Delaware Contraceptive Access Now and Contraceptive Initiation Among Medicaid Enrollees, 2015‒2020

Abstract

Delaware Contraceptive Access Now was a statewide contraceptive access program implemented in Delaware between 2015 and 2020. We evaluated the association of the program with contraceptive initiation in Delaware’s Medicaid program using a difference-in-differences design that compared changes in Delaware to changes in Maryland. Results suggest that program implementation was associated with increased initiation of long-acting reversible methods, particularly among adolescent patients aged 15 to 18 years. We found less-consistent evidence for changes to any contraceptive method. (Am J Public Health. 2022;112(S5):S537–S540. https://doi.org/10.2105/AJPH.2022.306938 )

The effect of contraceptive access reform on privately insured patients: Evidence from Delaware Contraceptive Access Now

“…Associations were largest for teenage enrollees where the LARC insertion rate increased by 1.1 percentage points, or 56% from the baseline rate in Delaware. This result is consistent with previous work on DelCAN in the Medicaid program which found larger effects for adolescents than adults and with evidence from Colorado that found that a similar program was particularly salient for teenagers [ 30 , 31 ]. Larger effects for adolescents could reflect higher demand for LARC in that age group, especially in the context of lower baseline insertion rates relative to older adults, coupled with the broad scope of the training program, which included pediatric and other primary care providers [ 32 ].…”

“…Our results are more consistent with analyses of DelCAN’s effect on LARC insertions in Medicaid which found that DelCAN was as associated with a 10% increase in LARC insertions among adult Medicaid enrollees and a 68% increase among adolescent enrollees [ 30 ]. Given that the private reimbursement systems were not reformed as part of the program, the consistency of our results suggests that training, which included clinical and business operations training, and capital support in the form of a “starter” supply of LARC devices, plays a key role in program effects.…”

Contraceptive access reform and abortion: Evidence from Delaware

“…There are several possible explanations for why we did not observe strong evidence of an effect on abortion from DelCAN, despite previous evidence that the program increased LARC use. First, we expected that effects on abortion would be contemporaneous with changes in contraceptive use observed in other studies 23–25 . However, program effects in Delaware may grow over time as providers continue to adapt to new practice styles and patients become more aware of available services, especially considering that the program components were gradually introduced over 2015–2020.…”

“…A separate study suggested that LARC use increased among Title X patients by 3.2 percentage points (a 40% increase from baseline) 23 . Increased LARC initiation has also been observed in Medicaid claims data 24 and in claims from large employers 25 . Analysis of the Pregnancy Risk Assessment Monitoring System (PRAMS) suggests that LARC use increased among postpartum patients 26 .…”

“…For example, existing work has not found statistically significant evidence of changes to other method types in Title X 23 . In Medicaid, moderate method use increased for 15 to 18 year olds, but decreased for older patients 24 . Among large employers, estimates of changes to other method types were inconclusive 25 …”