Contraceptive services in the safety net: Interdisciplinary innovations in using electronic health record data to study the impact of the ACA
Awarded 2016
Interdisciplinary Innovation (Phase 2) Grants
Blair Darney, PhD, MPH
Oregon Health & Science University

Objectives: We describe payor for contraceptive visits and uptake of long-acting reversible contraception (LARC) during 2013 and 2014, before and after Affordable Care Act (ACA) implementation, in a network of diverse Community Health Centers (CHCs) and estimate the relative contributions of the ACA, Title X, and state 1115 or SPA family planning programs to insurance and contraceptive services among states that expanded Medicaid. Methods: Our sample included 246 (CHCs) with a common electronic health record. We identified contraceptive visits among women 10-49. Our outcomes were lack of insurance for a contraceptive visit, and provision of LARC among those visits with a contraceptive order. We included relevant visit/woman, clinic, county, and state-level variables and used time series and logistic regression and calculated predicted probabilities. Results: Medicaid expansion has resulted in fewer uninsured/self-pay contraceptive visits and proportion of contraceptive orders that are Tier 1 was relatively stable. Conclusion: Insurance for contraceptive visits has increased across CHCs in both expansion and non- expansion states. There is a continued role for Title X and 1115 waivers in the provision of payment for contraceptive visits and especially in the provision of LARC services among expansion states. In addition to protecting insurance gains under the ACA, Title X and state 1115 programs should continue to be a focus of health policy research and advocacy.