Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005–2015

Decker, Emily; Ahrens, Katherine A.; Fowler, Christina; Carter, Marion; Gavin, Lorrie; Moskosky, Susan

doi:10.1089/jwh.2017.6465

Cited by 6 publications

(6 citation statements)

References 11 publications

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“…Research using clinic-level data has demonstrated that Title X clinics provide better access to LARC methods than non–Title X clinics . Historically, Title X has been the most important payer for contraceptive services for women with low incomes, and the exit of Planned Parenthood and individual states from the Title X program may intensify the role of non–Title X CHCs as publicly funded contraceptive care providers…”

Section: Discussionmentioning

confidence: 99%

“…We identified patients who visited a Title X clinic within the measurement year because Title X clinics are known to provide broader range of contraceptive methods, including LARC . Title X funding status of the clinic was determined from data from the OPA .…”

Section: Methodsmentioning

confidence: 99%

“…We identified patients who visited a Title X clinic 32 within the measurement year because Title X clinics are known to provide broader range of contraceptive methods, including LARC. 22,[33][34][35] Title X funding status of the clinic was determined from data from the OPA. 36 Urban vs rural status was assigned to each patient using Rural-Urban Commuting Area codes 37 based on each patient's primary clinic address.…”

Section: Clinic-level Covariatesmentioning

confidence: 99%

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Evaluation of Medicaid Expansion Under the Affordable Care Act and Contraceptive Care in US Community Health Centers

et al. 2020

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IMPORTANCE Use of effective contraception decreases unintended pregnancy. It is not known whether Medicaid expansion under the Affordable Care Act increased use of contraception for women who are underserved in the US health care safety net. OBJECTIVE To evaluate the association of Medicaid expansion under the Affordable Care Act with changes in use of contraception among patients at risk of pregnancy at US community health centers, with the hypothesis that Medicaid expansion would be associated with increases in use of the most effective contraceptive methods (long-acting reversible contraception). DESIGN, SETTING, AND PARTICIPANTS This was a participant-level retrospective cross-sectional study comparing receipt of contraception before (2013) vs immediately after (2014) and a longer time after (2016) Medicaid expansion. Electronic health record data from a clinical research network of community health centers across 24 states were included. The sample included all female patients ages 15 to 44 years at risk for pregnancy, with an ambulatory care visit at a participating community health center during the study period (315 clinics in expansion states and 165 clinics in nonexpansion states). EXPOSURES Medicaid expansion status (by state). MAIN OUTCOMES AND MEASURES Two National Quality Forum-endorsed contraception quality metrics, calculated annually: the proportion of women at risk of pregnancy who received (1) either a moderately effective or most effective method (hormonal and long-acting reversible contraception) methods and (2) the most effective method (long-acting reversible contraception). RESULTS The sample included 310 132 women from expansion states and 235 408 women from nonexpansion states. The absolute adjusted increase in use of long-acting reversible contraceptive methods was 0.58 (95% CI, 0.13-1.05) percentage points greater among women in expansion states compared with nonexpansion states in 2014 and 1.19 (95% CI, 0.41-1.96) percentage points larger in 2016. Among adolescents, the association was larger, particularly in the longer term (2014 vs 2013: absolute difference-indifference , 0.80 [95% CI, 0.30-1.30] percentage points; 2016 vs 2013: absolute difference, 1.79 [95% CI, 0.88-2.70] percentage points). Women from expansion states who received care at a Title X clinic had the highest percentage of women receiving most effective contraceptive methods compared with non-Title X clinics and nonexpansion states. CONCLUSIONS AND RELEVANCE In this study, Medicaid expansion was associated with an increase in use of long-acting reversible contraceptive methods among women at risk of pregnancy seeking care in the US safety net system, and gains were greatest among adolescents.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Clinic-level Covariatesmentioning

confidence: 99%

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Evaluation of Medicaid Expansion Under the Affordable Care Act and Contraceptive Care in US Community Health Centers

et al. 2020

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“…Many studies (n = 53) examined the impact of the ACA (signed into law in 2010) on contraceptive access, finding that the ACA decreased rates of uninsurance among American women (Decker et al, 2018;E. M. Johnston & McMorrow, 2020;Jones & Sonfield, 2016;Kavanaugh et al, 2018;MacCallum-Bridges & Margerison, 2020;Riddell et al, 2018;Willage, 2019) and increased the proportion of patients paying for services with insurance (Arora & Desai, 2016).…”

Section: Affordable Care Actmentioning

confidence: 99%

Policy impacts on contraceptive access in the United States: a scoping review

Swan

2023

J Pop Research

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Contraceptive access is influenced by policy decisions, which can expand and constrict the contraceptive options available. This study explored the impact of recent US federal policies on contraceptive access by identifying and reviewing empirical literature, which is then presented and discussed using Levesque et al.’s (2013) healthcare access framework. A scoping review was conducted to identify empirical studies (N = 96) examining the impact of recent federal policy (passed from 2009 to 2019) on contraceptive access. Most identified studies examined the role of the Affordable Care Act (n = 53) and Title X of the Public Health Service Act (n = 25), showing many benefits of both policies for contraceptive access, particularly through improved affordability, availability, and appropriateness of contraceptive care. Other identified studies examined the impact of policies funding abstinence-only sex education (n = 2) and the Teen Pregnancy Prevention Program (n = 3), military policies related to the availability of contraception (n = 1), guidelines for quality contraceptive care (n = 3), Title IX of the Education Amendments (n = 4), the Violence Against Women Act (n = 1), and the Veterans Access, Choice, and Accountability Act (n = 4). Through increased outreach efforts, normalising of care, availability of services, cost subsidies, and provider competencies, recent federal policy has, overall, enhanced contraceptive access across the dimensions of healthcare access. Numerous policy and practice gaps and needs are identified, and future directions for research, policy, and practice are suggested.

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“…In states that did not adopt the expansion, Medicaid coverage increased far less, from 23% to 26%. 7 However, this descriptive study did not isolate the causal impact of Medicaid expansion and it did not consider the effects of expansion on other outcomes such as client volumes or the mix of services provided. An analogous body of research has examined the effect of expansion on other types of safety-net clinics.…”

Section: Introductionmentioning

confidence: 99%

Medicaid Expansion at Title X Clinics

Boudreaux

Choi²,

Xie³

et al. 2019

Medical Care

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Background.-Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act's Medicaid expansion. Objectives.-To examine the impact of the Affordable Care Act's Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix. Research Design.-A difference-indifferences design compared changes in the outcomes of interest before and after expansion, for expansion versus non-expansion states. Subjects.-Administrative data from Family Planning Annual Reports that describe Title X clients who sought services. Measures.-Female client volume was measured using a participation ratio defined as the number of female clients per 100 women age 15-44 with incomes less than 250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type. Results.-We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those esults were somewhat sensitive to model specification.

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Trends in Health Insurance Coverage of Title X Family Planning Program Clients, 2005–2015

Abstract: Although clients attending Title X clinics remained uninsured at substantially higher rates compared with the national average, the increase in clients with health insurance coverage aligns with the implementation of ACA-related provisions to expand access to affordable health insurance.

Cited by 6 publications

References 11 publications

Evaluation of Medicaid Expansion Under the Affordable Care Act and Contraceptive Care in US Community Health Centers

Evaluation of Medicaid Expansion Under the Affordable Care Act and Contraceptive Care in US Community Health Centers

Policy impacts on contraceptive access in the United States: a scoping review

Medicaid Expansion at Title X Clinics

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