Impact of Medicaid family planning eligibility expansion on contraceptive use of low income women

Introduction: This study estimates the impact of Medicaid family planning waivers on the use of more effective contraceptive methods among low income women at risk of unintended pregnancy. Methods: We identified 1,736 low-income (<185%FPL) women without private insurance, at risk for unintended pregnancy from the 2006-10 National Survey of Family Growth. State-level policy data and contextual data from the NSFG were merged to the NSFG public use file for the analysis. States were classified based on 2006 status as having: 1) income based expansions, 2) expansions for those losing Medicaid coverage, 3) No Medicaid expansions (reference). Contraceptive use in the month of interview was classified as: 1) female sterilization 2) prescription methods 3) over-the-counter methods which may be covered by Medicaid 4) methods unlikely to be covered by Medicaid and 5) No method used (reference). Polytomous logistic regression was conducted. Results: In the sample, 39% of women lived in a state with an income-based expansion. The most commonly used methods were sterilization (44.5%) and prescription contraceptives (25%). Approximately 10% of women reported no method use. Compared to women living in no-expansion states, those living in states with income waivers were no more or less likely to use more effective contraceptive methods [AORsterilization:0.97 (95%CI 0.50-1.89); AORprescription 1.28 (0.68-2.39); AORotc 0.49 (0.24-1.02); AORuncovered: 0.99 (0.38-2.60)]. There were similar findings for women living in limited expansion states. Conclusions: Medicaid family planning waivers may not be reaching women in need of publicly funded contraceptive services and additional research should be conducted.