Medicaid Family Planning Programs and Contraceptive Autonomy: A Comparative Analysis of Four U.S. States

Contraception, otherwise known as birth control, is when individuals use a single contraceptive method, like a device or medication, or a combination of two or more methods to prevent pregnancy. In the United States, contraceptive methods are designed, improved, and perfected by private or public organizations. The U.S. Food and Drug Administration (FDA) approves methods to ensure efficacy and trustworthiness for consumer use. Contraceptive access is fundamental to healthcare to prevent or plan a pregnancy, which in turn may allow reproductive-aged men and women to achieve their desired level of socioeconomic and individual-level freedoms. Medicaid, a state-federal program for low-income individuals, is the largest single-payer for contraception, covering 75% of publicly funded family planning services. Federal law outlines the minimum standards for family planning services covered in state Medicaid programs, where each state allows a certain percentage of funding for contraception available to their respective Medicaid beneficiaries. Despite these federal baseline rules, state-by-state variation in contraceptive coverage and accessibility creates uncertainty around the options available, which can cause individuals to forgo treatment or make a suboptimal reproductive health decision. This paper discusses the [burden] variation in state contraceptive availability in Pennsylvania, West Virginia, Ohio, and Maryland Medicaid programs. The paper will provide evidence of the need for increased contraceptive autonomy for Medicaid beneficiaries and how may reduce socioeconomic barriers. Recommendations to improve access to contraception to increase contraceptive autonomy will clarify the coverage mandates for contraception by the federal government and focus on the navigability of the state-regulated government website. The limitations of this analysis are also discussed. Public Health Significance: State-by-state program implementation variations can lead to decreased access and knowledge when an individual seeks contraceptive services. In the United States more than thirty million females are enrolled in Medicaid and more than half are under 50. This policy brief will identify the different structural components of Medicaid Family Planning Services in Pennsylvania, Ohio, West Virginia, and Maryland. The future implementation recommendations will provide valuable references for policymakers and Medicaid beneficiaries for a safe and effective understanding of contraceptive options and how access to these services varies