Medicaid Expansion at Title X Clinics

Abstract

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.

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

“…11 Recent studies suggest that the number of women receiving contraceptive services in primary care settings increased in Medicaid expansion states after ACA implementation, [12][13][14] and more women in safety net clinics used insurance to pay for contraceptive services after Medicaid expansion. 15 Research to date on publicly funded contraceptive services has focused on 1 of 3 mechanisms (Medicaid, single payers [eg, state family-planning programs], 16 or federal programs [Title X] [17][18][19] ) or has included only clinics with a reproductive health focus or those known to provide publicly funded contraceptive services. [20][21][22] We have little evidence collected across the safety net system that also includes programs, such as Title X, that pay for contraceptive services in the safety net.…”

Postpartum Contraceptive Use, Pregnancy Intentions in Women With and Without a Delivery of a NAS-Affected Infant in Delaware, 2012-2018

“…14,30,31 During our 2012-2018 study period, Delaware saw a significant increase in use of long-acting reversible contraceptives in Title X and Medicaid populations. 32,33 A statewide data brief indicated that there was 107% increase in reversible contraceptive methods during 2012-2018, and a 17% percent increase in the percent of Delaware women indicating their pregnancy was intended. 34 Although our study did not find statistically significant differences in effective postpartum contraceptive use among women with an NAS-affected and non-NAS delivery, the low prevalence of effective postpartum contraceptive methods for both groups suggest that sustained and continued statewide efforts that are non-coercive and culturally appropriate may be needed to increase access to effective methods of contraceptives.…”

Accessibility of federally funded family planning services in South Carolina and Alabama

“…The affordability scales had the highest access scores, which affirmed existing clinic policies ensuring the affordability of services. FQHC clinics scored higher on the affordability: insurance policy subscale than HD clinics, suggesting that Title X clinics are not constrained by the insurance contracts accepted at the clinic ( Boudreaux et al, 2019 ). Many patients who seek care at Title X clinics are uninsured, and of patients who have health insurance, most do not use health insurance for the visit because insurance may not cover specific services or due to confidentiality concerns ( Kavanaugh et al, 2018 ).…”