State officials have demonstrated enormous creativity and entrepreneurship in designing and implementing Medicaid family planning expansions, according to a new Guttmacher Institute analysis. Even beyond reproductive health care, the innovations identified in the report are highly relevant to the broader health care reform debate, since any efforts to expand health care coverage for low-income women are likely to build extensively on the framework provided by Medicaid and SCHIP.

"Although numerous studies have documented the positive impact of family planning expansions in providing essential care to low-income Americans, no previous studies looked in detail at how these expansions have been implemented nationwide," says Adam Sonfield, the report’s lead author. "State and federal policymakers have made numerous decisions, large and small, that have shaped the various expansions."

Among the key findings outlined in the report are best practices and innovative approaches in several areas.

• Most notably, states have pioneered new techniques to make it easier for clients to apply for the program—and in some cases even enroll— during a family planning visit.
• In other steps to streamline the enrollment process, states have automatically enrolled potential clients, such as postpartum women who are leaving Medicaid, and used databases to verify citizenship status and income.
• To reach out to clients, states have used tailored, community-based tactics, established informative program Web sites and contacted individuals receiving other forms of public assistance.
• To recruit a large network of providers, states have worked with professional organizations and associations, used targeted ads, e-mails and mailings, and developed Web sites for interactive orientation and training.
• To ensure adequate provider reimbursement, states have strived for regularly scheduled rate increases and targeted funding for client counseling and application assistance.
• To guarantee client confidentiality, states have enrolled teens based on their own (rather than their parents’) income and enrolled clients unable to use private insurance for fear of abuse.

"Many of the issues that policymakers have grappled with in the context of these expansions—reaching out to new populations, streamlining enrollment and working effectively with a state’s provider network—are universal," says Sonfield. "Therefore, the report should not only be of great interest to state officials, policymakers, advocates and others who are directly involved in family planning expansions, but can also serve future program design for Medicaid and health care reform more broadly."

About Medicaid family planning expansions

Three-quarters of the U.S. women estimated to be in need of publicly subsidized contraception live in one of the 26 states that have some form of expanded Medicaid family planning eligibility. These programs have assisted millions of low-income people who otherwise might have had no source of coverage for family planning.

Click here to read "State Government Innovation in the Design and Implementation of Medicaid Family Planning Expansions," by Adam Sonfield, Casey Alrich and Rachel Benson Gold.