Potential Role of Family Planning in an Era of Health Care Reform: Patient Perspectives on Primary Care Needs and Insurance Eligibility

With the implementation of the Affordable Care Act (ACA), millions of Californians are eligible for Medicaid or for premium tax credits. California’s Family PACT Program provides family planning services to 1.8 million low-income and often uninsured residents. Family PACT serves as an entry point into the health care system for clients needing a medical home by encouraging providers to screen and refer clients for primary care services. The current study explored pre-ACA perspectives on primary care and health insurance eligibility screening and referral in a survey of 1,498 Family PACT clients in 2012. Nearly two-thirds of Family PACT clients paid out-of-pocket to access primary care services, and nearly 25% did not have a usual source of care for general health concerns. However, these clients were less likely to be asked about their primary care needs than their counterparts. Similarly, Hispanic and Spanish-speaking clients were significantly less likely to be assessed for primary health care needs than White or English-speaking clients respectively. Clients who usually pay for primary care services out-of-pocket were less likely to discuss Medicaid eligibility with their provider than clients whose insurance or provider covered their health care costs (13% versus 24%). Although it remains to be seen how many Family PACT clients will enroll in insurance options provided by the ACA, this study highlights the current gaps in health care access for Family PACT clients, while providing insights into the types of providers and clients that may need additional support and outreach during health care reform implementation.