Arkansas Women's Health Waiver: Achieving social justice with cost-effective reproductive health services

During times of economic recession, it is important to recognize state and federal programs that achieve positive outcomes for vulnerable populations while consistently reducing government spending. The Arkansas Women's Health Waiver (WHW) is one such policy initiative designed to improve access to family planning services for women with incomes ≤ 200% of FPL. The Arkansas waiver has been cost-effective since its inception in 1997, saving the state an estimated $552 million by averting 46,000 births over the 12-year period. The waiver has also resulted in improved birth spacing and maternal age at first Medicaid birth (24.8 years) for waiver participants. However, rates of utilization have been decreasing. This abstract describes three unique components of the ongoing waiver evaluation, each investigating means to improve utilization. A random sample phone survey of 623 eligible non-service users addressing decreasing utilization rates found that non-users were not aware they were enrolled or did not know where to obtain services. Another random sample survey of 619 service users helped clarify whether women were being treated (63%) or referred (32%) for other health care needs by their family planning providers, what percent followed up (50%), and the most common reasons for not obtaining necessary health care (financial and lack of knowledge of where to obtain care). The third component, a survey of reproductive health providers in the state to evaluate awareness of and attitudes toward the waiver program, is ongoing. The presentation will conclude with recommendations for improving participation rates, both for service users and providers.