A new report that pulls together the body of evidence from evaluations of state programs that have expanded Medicaid eligibility for family planning finds that the benefits they provide are broad and far-reaching. According to "Medicaid Family Planning Expansions: Lessons Learned and Implications for the Future," by Adam Sonfield and Rachel Benson Gold of the Guttmacher Institute, these programs have proven both effective and cost-effective, while simultaneously pioneering innovations in outreach and enrollment that hold important lessons for the implementation of health care reform.
Between 1997 and 2011, 22 states expanded eligibility for family planning under their Medicaid programs to women (and, in half of those states, to men) not otherwise Medicaid-eligible—in almost all cases up to 185% or 200% of the federal poverty level. These states account for two-thirds of U.S. women in need of publicly subsidized family planning services and supplies. Together, the Medicaid expansion programs serve about 2.7 million women and men each year, substantially increasing the proportion of the need for services that states are able to meet. Publicly funded family planning centers in states with expansions served 48% of women in need in 2006, whereas those in nonexpansion states served just 36%.
Taken collectively, state and national evaluations of these programs clearly demonstrate that expanding family planning services under Medicaid increased women’s contraceptive use, increased their use of more effective methods and improved their continuity of use—all important factors in reducing high rates of unintended pregnancy among low-income women. This improvement in contraceptive use translated into measurable declines in unplanned pregnancy and teen pregnancy, and the births, abortions and miscarriages that would otherwise have resulted. It has also helped women to plan and space their pregnancies, which has positive implications for the health of pregnant women and newborns, as well as the economic and social well-being of families.
"The body of evidence is clear," says author Adam Sonfield. "Expanding eligibility for contraceptive services under Medicaid has enabled women to access the services they want and need, while reducing the toll on federal and state taxpayers. As if that weren’t enough, these expansions have also resulted in innovative outreach and enrollment practices, which can serve as models for the implementation of the Affordable Care Act."
Innovations in outreach and enrollment have been widespread in the Medicaid family planning expansion programs. To reach new clients, state agencies have taken such actions as establishing Web sites and hotlines, and creating linkages with other social service programs. To streamline enrollment, they have used tactics such as offering online applications, using government databases to verify eligibility, and facilitating applications and enrollment at the point of service to allow patients to be treated immediately. These types of best practices have vastly reduced the obstacles women need to overcome to access services.
Click here for "Medicaid Family Planning Expansions: Lessons Learned and Implications for the Future," by Adam Sonfield and Rachel Benson Gold.
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