Annette L. Amey, PhD, Provider Services, California Family Health Council, 2550 Ninth Street, Suite 110, Berkeley, CA 94710, 510 486-0412 Ext 2318, ameya@cfhc.org, Laurie Zabin, PhD, Bill and Melinda Gates Institute for Population and Reproductive Health, Johns Hopkins School of Public Health, 615 N. Wolfe St., Room W4503, Baltimore, MD 21205, and CS Minkovitz, MD, MPP, Women's and Children's Health Policy Center, Johns Hopkins University, 624 N. Broadway, Baltimore, MD 21205.

Medicaid is the largest source of public funding for family planning programs, providing half of all public dollars spent on contraception. This research contributes to our understanding of changes in the health care delivery system by analyzing qualitative data from 130 Medicaid recipients in mandatory managed care at clinic and non-clinic locations. An analysis of providers shows no increase of private physicians new to serving the Medicaid population through the managed care program; recipients are heavily dependent on the safety net providers who have traditionally served the Medicaid population. The majority of recipients, 68%, seek family planning services from their usual source of care to maintain continuity of care, convenient location, and the ability to get appointments quickly. Other recipients, 17%, chose a different provider because they were unable to get a timely appointment at their usual source of care, confidentiality, staff, and a desired service was not available. Knowledge of the Family Planning Exemption, which allows recipients to seek contraceptive care from any qualified provider, was poor at all clinic sites; 65% of recipients did not know about the Exemption. This lack of knowledge was problematic and created access barriers for recipients who attempted to seek care outside of their usual source of care. Rates of having ever discontinued a contraceptive method were similar at all sites, however, the non-clinic sites or clinic sites not focusing on reproductive health had a much higher proportion of recipients who were not using contraception and were exposed to an unintended pregnancy.

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