Medicaid Expansion Programs Improve Women's Access to Reproductive Services
One-third of the women enrolled in Michigan’s Medicaid expansion program reported improved access to birth control and family planning services.
According to a study published in JAMA Network Open, a third of the women enrolled in Michigan's Medicaid expansion program reported improved access to birth control and family planning services compared with the access they experienced before enrolling. The ability to access these services was further associated with younger age, having no previous heath insurance coverage, and a recent primary care visit.
The authors of this survey study sought to evaluate the association between obtaining Medicaid expansion coverage and the ability to access family planning services and birth control among women of a reproductive age enrolled in the Michigan expansion plan.
The study sample included 1166 women aged 19 to 44 years enrolled in Michigan's Section 1115 Medicaid expansion waiver program, the Healthy Michigan Plan, for at least 12 months preceding the study. These women participated in a telephone survey — provided in English, Arabic, or Spanish — conducted from January 13 through December 15, 2016. Participants reported change in access to family planning services and birth control by responding better, worse, about the same, or don't know/doesn't apply. In addition, the survey measured demographic characteristics, health status, insurance status, and access to and use of health care services. The study sample was weighted to a population of 113,565 women.
Of the 1166 respondents, 74.7% (95% CI, 72.2%-76.9%) lived in very low-income (defined as being below the federal poverty level) households; 17.7% (95% CI, 15.7% -19.9%) lived in rural settings. The proportion of participants reporting at least 1 chronic medical condition was 64% (95% CI, 60.5%- 67.3%), with 23.5% (95% CI, 20.6%-26.6%) reporting fair or poor health. Overall, 35.5% (95% CI, 32.2%-39%) of the women reported an improvement in their ability to access birth control and family planning services; 24.8% (95% CI, 21.8%-28.0%) said they had about the same ability to access reproductive care, and 1.4% (95% CI, 0.8%-2.5%) reported decreased ability.
Women without health insurance for the year preceding Medicaid enrollment were twice as likely to report increased access to family planning services (adjusted odds ratio [aOR], 2.02; 95% CI, 1.41-2.89), compared to women with coverage for 12 months preceding enrollment. Younger women, aged 19 to 24 years (aOR, 2.80; 95% CI, 1.75-4.50), were significantly more likely than women aged 35 to 44 years to report an improvement in access after acquiring coverage. Women who recently visited a primary care provider (aOR, 1.69; 95% CI, 1.03-2.76) were also more likely to report better access to reproductive services than women who had not seen a doctor in the past year; however, the difference was not significant.
Limitations of the study were including only women of reproductive age and using self-reported measurements on access to family planning services. By including women not at risk of unintended pregnancy, the reported associations were likely underestimated. Finally, because the study was limited to the effect of Medicaid expansion in one state, the results might not be generalizable to other geographic locations.
Improved access to birth control and family planning services was significantly associated with enrollment in Medicaid expansion, specifically of younger women, women who recently saw a primary care physician, and women who did not have coverage in the year prior to enrolling. Further studies are needed to understand whether improved access to birth control and family planning services translates into better reproductive health outcomes.
Moniz MH, Kirch MA, Solway E, et al. Association of access to family planning services with Medicaid expansion among female enrollees in Michigan [published online August 31, 2018]. JAMA Netw Open. doi:10.1001/jamanetworkopen.2018.1627