Title X–Funded Health Center Staff Members' Perspectives on Barriers to Insurance Use For Confidential Family Planning Services

Leah E. Masselink, George Washington University Julie Lewis, National Family Planning and Reproductive Health Association Clare Coleman, National Family Planning and Reproductive Health Association Susan F. Wood, George Washington University

First published online:

| DOI: https://doi.org/10.1363/psrh.12054
Abstract / Summary

Under the Affordable Care Act (ACA), the number of patients who have health insurance among those receiving family planning and reproductive health services at Title X–funded health centers has grown. However, billing some patients’ insurance for services may be difficult because of Title X's extensive confidentiality protections. Little is known about health centers’ experiences in addressing these difficulties.


Eight focus group discussions were conducted with a convenience sample of 54 Title X–funded health center staff members and state program administrators in January and April 2015. Transcripts were examined through thematic analysis.


Participants identified five key barriers to centers’ ability to bill patients’ health insurance. Insurance providers’ policyholder communications (e.g., explanations of benefits or patient portal postings) can threaten confidentiality for patients insured as dependents. Patients and providers are sometimes confused about insurance providers’ confidentiality protections; centers are hesitant to bill insurance when protections are unclear. Changes in Medicaid family planning waiver coverage in some states have added to this uncertainty. Health centers can encounter significant administrative burdens when billing insurance while trying to protect patients’ confidentiality. Finally, patients sometimes hesitate to use their insurance because of financial or other concerns.


Title X–funded health centers face several barriers to their ability to bill patients’ health insurance while maintaining confidentiality protections. As a result, they are likely to continue relying on Title X funds to cover services for some insured patients despite the expansion of health insurance under the ACA.

Author's Affiliations

Leah E. Masselink is assistant professor, and Susan F. Wood is professor, of health policy and management, George Washington University, Washington, DC. At the time this study was conducted, Julie Lewis was policy director at the National Family Planning and Reproductive Health Association (NFPRHA), Washington, DC. Clare Coleman is president and CEO of NFPRHA.


The views expressed in this publication do not necessarily reflect those of the Guttmacher Institute.