Payment for Contraceptive Services in Safety Net Clinics

Roles of Affordable Care Act, Title X, and State Programs

Datos Bibliográficos

ID9101372
AutoresBlair G Darney (0000-0001-8120-028X, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, autor de correspondencia), Frances M Biel (0000-0002-9857-8729, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, autor de correspondencia), María Isabel Rodríguez (0000-0002-3127-2581, Oregon Health & Science University, autor de correspondencia), R Lorie Jacob (0000-0003-3709-7806, OCHIN Inc.), Erika K Cottrell (0000-0003-0481-4485, OCHIN Inc.), Jennifer E Devoe (0000-0003-4812-6852, Department of Family Medicine, Oregon Health and Science University, Portland, OR)
Año2020
Volumen58
Número5
Páginas453-460
Fecha de publicación2020-05-01
Peer ReviewedSí
Open AccessNo
TipoARTICLE
RevistaMedical Care (JOURNAL)
Identificadores de la revistaISSN: 0025-7079 • E-ISSN: 1537-1948
EditorialOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0000000000001309
PMID32049877
OpenAlexW3006476510
IdiomaEN
Citas recibidas4
Referencias citadas39

OBJECTIVES: We describe payor for contraceptive visits 2013-2014, before and after Medicaid expansion under the Affordable Care Act (ACA), in a large network of safety-net clinics. We estimate changes in the proportion of uninsured contraceptive visits and the independent associations of the ACA, Title X, and state family planning programs. METHODS: Our sample included 237 safety net clinics in 11 states with a common electronic health record. We identified contraception-related visits among women aged 10-49 years using diagnosis and procedure codes. Our primary outcome was an indicator of an uninsured visit. We also assessed payor type (public/private). We included encounter, clinic, county, and state-level covariates. We used interrupted time series and logistic regression, and calculated multivariable absolute predicted probabilities. RESULTS: We identified 162,666 contraceptive visits in 219 clinics. There was a significant decline in uninsured contraception-related visits in both Medicaid expansion and nonexpansion states, with a slightly greater decline in expansion states (difference-in-difference: -1.29 percentage points; confidence interval: -1.39 to -1.19). The gap in uninsured visits between expansion and nonexpansion states widened after ACA implementation (from 2.17 to 4.1 percentage points). The Title X program continues to fill gaps in insurance in Medicaid expansion states. CONCLUSIONS: Uninsured contraceptive visits at safety net clinics decreased following Medicaid expansion under the ACA in both expansion and nonexpansion states. Overall, levels of uninsured visits are lower in expansion states. Title X continues to play an important role in access to care and coverage. In addition to protecting insurance gains under the ACA, Title X and state programs should continue to be a focus of research and advocacy

Confidence interval · Environmental health · Family medicine · Family planning · Health care · Health insurance · Logistic regression · Medicaid · Patient Protection and Affordable Care Act · Population · Safety net · Demography · Global Maternal and Child Health · Healthcare Policy and Management · Internal Medicine · Medicine · Reproductive Health and Contraception