State-Level Trends in Access to Medicaid Family Planning Services, 2008 – 2023

OBJECTIVES: Family planning services are critical for reducing unplanned pregnancies, preventing certain cancers and the acquisition of infectious diseases, and improving downstream health outcomes in women who eventually become pregnant. The landscape of policies that determines funding for family planning services has seen substantial changes over the past 15 years. As a basis for understanding the impact of Medicaid on family planning related health outcomes, this study characterizes the full- or limited-benefit Medicaid programs that provide family planning services, across states from 2008 through 2023.

METHODS: We combined information on Medicaid section 1115 family planning waivers, family planning state plan amendments (SPAs), and full-benefit Medicaid eligibility criteria from 2008 through 2023. Data from the American Community Survey was used to estimate the proportion of women aged 19-44 who were eligible for family planning services through either full- or limited-benefit Medicaid programs and to identify the key determinants of changes in eligibility, by state and year. We also collected data on enrollment or utilization of limited-benefit Medicaid family planning programs when available.

RESULTS: Income eligibility thresholds for family planning through Medicaid generally increased (became less restrictive) following the implementation of the Affordable Care Act, most often due to states adopting family planning SPAs and expanding full-benefit Medicaid. However, the proportion of women aged 19-44 eligible has paradoxically decreased since 2012 largely because of concurrent decreases in poverty and increases in private insurance. The decrease in eligibility has been concentrated in parents, while eligibility for women without children has remained relatively steady.

CONCLUSIONS: Changes in the size and makeup of populations eligible for Medicaid family planning may impact how women access reproductive healthcare. Our work highlights intricacies in the family planning policy landscape that are consequential for studying trends in reproductive health outcomes.