Preventive and reproductive health services for women: the role of California's family planning waiver

Abstract

Purpose: Examine effects of a Medicaid family planning waiver on the receipt of reproductive health care and pregnancy.

Design: The present study uses a quasi-experimental design using data from the California Women's Health Survey and the Behavioral Risk Factor Surveillance System (BRFSS) for exposure and comparison groups, before and after California's Planning Access Care and Treatment waiver.

Setting: The setting was California and comparison states.

Subjects: The study included women who were ages 18 to 44 years and below 200% of the federal poverty level (FPL), who are eligible for services under the waiver.

Measures: The study measured self-reported pregnancy and receipt of routine checkup, clinical breast exam, Pap test, Chlamydia screening, and discussion of birth control with provider in the past year.

Analysis: The study analyzes outcomes for exposure and comparison groups using probit regression models based on data both within California and in states without waivers.

Results: Estimates from the California Women's Health Survey analysis indicate that among parents 100% to 200% of the FPL, the waiver led to an 8-percentage point increase in the receipt of a routine checkup and a 12-percentage point increase (p = .03) in discussion of birth control. There was an estimated 3-percentage point decline (p = .05) in current pregnancies among nulliparous women. Multistate analysis using the BRFSS confirmed positive effects on routine checkups (p < .01).

Conclusions: The waiver appears to have led to a reduction in pregnancy rates and increased receipt of reproductive health care, particularly routine checkups.