While the 2022 US Supreme Court decision in Dobbs v Jackson Women’s Health Organization was about abortion, there is also evidence of its impact on both the demand for contraception and state-level availability of contraception services with the closure of family planning clinics that provided both abortion and contraceptive care. Medicaid is the largest payer of family planning services and maternity care, and its enrollees are especially vulnerable to policy changes and their consequences given their reliance on the family planning safety net. In the same time frame that states were instituting state-level abortion bans, rapid changes in Medicaid enrollment were also occurring. Medicaid saw record high numbers of recipients during the COVID-19 public health emergency due to mandated continuous Medicaid enrollment, followed by rapid dis-enrollments during subsequent unwinding. While the majority of states participating in Medicaid expansion under the Affordable Care Act had already done so by the mid-2010s, eight states initiated Medicaid expansion between 2019-2024.

For the past decade, our multidisciplinary team of reproductive health policy research experts has been studying the impact of federal and state-level contraception coverage policies on the use of contraception, its cost to consumers, and public health outcomes. We propose these research questions: 1) How have state-level abortion restrictions impacted the use of contraceptive methods and sterilization? and 2) How have policies that affect Medicaid enrollment, including Medicaid expansion, continuous Medicaid enrollment during the COVID-19 pandemic and subsequent unwinding, and postpartum coverage extension impacted the use of contraceptive methods and sterilization?