Impact of Medicaid Family Planning Waivers
on Internatal Coverage, Service Use, and
Birth Intervals of Low-Income Women
Presented by
Susan Haber, RTI International
Norma Gavin, IMPAQ International
Presented at
AcademyHealth Annual Research Meeting
Chicago, IL • June 30, 2009
www.rti.org
Phone 781-434-1721 • Fax 781-434-1701 • e-mail shaber@rti.org
RTI International is a trade name
of Research Triangle Institute
Unintended Pregnancies
 Unintended pregnancies are associated with a wide
range of poor maternal and child outcomes
–

Almost half of pregnancies in the United States are unplanned
and low-income women have 4 times higher risk
Increasing use of preconception care can reduce
unintended pregnancies
–
CDC recommended increasing insurance coverage of low-income
women to improve access to preconception care
 Medicaid covers 37% of low-income reproductive age
women and pays for more than 1/3 of all births
 Although Medicaid covers family planning services, many
women are not enrolled during preconception period
–
Many women do not qualify for Medicaid until they become pregnant,
and they lose Medicaid eligibility 60 days after delivering
Medicaid Family Planning Waivers
 27 states have expanded Medicaid eligibility through
family planning waivers
–
Provides Medicaid coverage to women who would not
otherwise qualify
–
But benefits are limited to family planning services
–
Eligibility varies by state
 Pilot study: Compare continuity of postpartum
Medicaid coverage, use of Medicaid-covered family
planning services, and birth intervals in two states –
one with and one without a family planning waiver
Pilot Study: Data and Methods
 Florida: waiver covers family planning services for 24
months following loss of full coverage for any reason
 Georgia: comparison, non-waiver state
 Data: Medicaid eligibility and claims for 1999-2001
 Study population: women with Medicaid-covered deliveries
in FY2000-FY2001
–
Florida: 120,414
–
Georgia: 113,584
 Estimation technique
–
Survival analysis for retention of Medicaid postpartum and
time to subsequent Medicaid-covered delivery
–
Descriptive analysis for use of family planning services
Percent of Women Remaining on
Medicaid Following Delivery, FL and GA
100
Percent of Women Still Enrolled in Medicaid
90
80
70
FL, teens
60
GA, teens
FL, w elfare-related adults
50
GA, w elfare-related adults
FL, poverty-related adults
40
GA, poverty-related adults
30
20
10
0
1
2
3
4
5
6
7
8
9
10 11 12 13 14 15 16 17 18 19 20 21 22 23
Months Since Medicaid-Covered Delivery
Percent of Women Remaining on Medicaid Following
Delivery: Waiver and Non-Waiver Beneficiaries, FL
Percent of Women Still Enrolled in Medicaid
100
90
80
70
Non-w aiver + w aiver, teens
60
Non-w aiver + w aiver, w elfare-related adults
Non-w aiver + w aiver, poverty-related adults
50
Non-w aiver, teens
Non-w aiver, w elfare-related adults
40
Non-w aiver, poverty-related adults
30
20
10
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23
Months Since Medicaid-Covered Delivery
Months to Second Medicaid-Covered
Delivery Among Teens: FL and GA
Percent with Second Medicaid-Covered Delivery
25
20
15
FL, teens
GA,teens
10
5
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
Months Since First Medicaid-Covered Delivery
 Longer interval between deliveries in Florida compared to Georgia
also found for welfare-related adults and poverty-related adults
Percentage of Women with Medicaid
Coverage Before Conception, FL and GA
Florida
(%)
Georgia
(%)
Teens
Welfarerelated
Adults
Povertyrelated
Adults
Teens
Welfarerelated
Adults
Povertyrelated
Adults
Had Medicaid 9 months
before 1st delivery
33
45
19
33
54
12
Had Medicaid 9 months
before 2nd delivery
96
95
96
59
80
46
Had Medicaid entire time
between deliveries
90
90
92
42
59
34
Percentage of Women Using Family Planning Counseling
Services in the 9 Months Following Delivery by Medicaid
Eligibility, FL and GA
 Less than a quarter of all
women eligible for family
planning counseling
received these services in
the 9 months following
delivery
 Beneficiaries eligible for
full Medicaid benefits
were equally or slightly
less likely to receive
family planning
counseling than
beneficiaries eligible for
only family planning
services
0
Percentage
20
40
Teens
Welfarerelated
adults
Povertyrelated
adults
FL, family planning only
FL, full benefits
GA
Percentage of Women Using Contraceptive Services in
the 9 Months Following Delivery by Medicaid Eligibility,
FL and GA
 Only half of the women
eligible for contraceptive
services received these
services in the 9 months
following delivery
0
Percentage
20
40
60
80
Teens
 Beneficiaries eligible for
full Medicaid benefits
were slightly more likely
to use contraceptive
services than
beneficiaries eligible for
only family planning
services
Welfarerelated
adults
Povertyrelated
adults
FL, family planning only
FL, full benefits
GA
Conclusions
 Florida’s family planning waiver substantially
increases the percentage of women who remain on
Medicaid following delivery
–
Very high enrollment retention due to automatic enrollment in waiver
program of women losing full Medicaid benefits
 Longer interval between deliveries is consistent with
better access to family planning services in Florida
under waiver program
–
May be influenced by other factors, not only family planning waiver
 Further research needs
–
Do Florida findings hold for family planning waivers in other states?
–
What are the impacts on maternal outcomes, neonatal outcomes,
and longer-term developmental outcomes in children?