Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including Sexual health services medicaid enrollees not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.
If you have no conflicts of interest, check "No Sexual health services medicaid enrollees conflicts of interest" in the box below. The information will be posted with your response. Those most likely to report increased access were women aged 19 to 24 It is vital to understand whether expanded health insurance coverage of low-income individuals improves access to family planning services as a first step toward improving reproductive health outcomes.
Interviewers completed surveys for Sexual health services medicaid enrollees enrollees, of whom were women aged 19 to 44 years. Surveys were conducted with a computer-assisted telephone interviewing system in English, Arabic, and Spanish. The sample was weighted to women.
Dates of data analysis were from January 27 through September Sexual health services medicaid enrollees, After adjusting, those most likely to report increased access were women without health insurance coverage in the year preceding HMP enrollment adjusted odds ratio [aOR], 2. This finding suggests that Medicaid expansion is associated with improved access to family planning services, which may enable low-income women to maintain optimal reproductive health.
Contraceptive care is an essential health service for women of reproductive age. What impedes contraceptive use? Most forms of birth control require a prescription eg, contraceptive pills, patch, ring or clinician
Sexual health services medicaid enrollees or insertion eg, contraceptive shot, intrauterine
Sexual health services medicaid enrollees, contraceptive implant.
The most effective contraceptive methods—including intrauterine devices, implants, and sterilization—are expensive but also cost-effective. Expanded health insurance coverage of low-income women may remove some critical barriers to contraceptive care, such as out-of-pocket costs for contraceptive methods and visits. However, expanded coverage may not translate into improved access to contraceptive services because of nonfinancial access barriers such as inadequate sources of reproductive health care, discomfort with health care clinicians, logistical barriers eg, child care, time off work, transportationdistance to a trained reproductive health clinician, and misinformation or health literacy.
Our study aimed to evaluate the association of obtaining Medicaid expansion coverage with access to birth control and family planning services among women enrolled in Michigan. We conducted a telephone survey of HMP enrollees as part of the formal evaluation of the Medicaid Section demonstration under contract Sexual health services medicaid enrollees the Michigan Department of Health and Human Services.
This study evaluating a public program followed the American Association for Public Opinion Research AAPOR reporting guidelines and was deemed exempt from review by the institutional review boards of the University of Michigan and Michigan Department of Health and Human Services and did not require Sexual health services medicaid enrollees consent.
Inclusion criteria were based on demographic characteristics available in the Michigan Department of Health and Human Services data warehouse at the time of sampling and included ages 19 to 64 years; initial HMP enrollment at least 12 months before sampling; enrollment in an HMP managed care plan for at least 9 months because most HMP enrollees are in managed care, and those who are not are not representative of the typical HMP experience ; preferred language of English, Spanish, or Arabic; and a complete Michigan address and telephone number.
Sampled HMP enrollees were mailed a letter and brochure that described the project and indicated the project team would call to discuss the survey; enrollees
Sexual health services medicaid enrollees also given the option to indicate their preferred time of day for the survey via postage-paid postcard, email, or toll-free number. The letter and brochure included general descriptions of the survey project, using language such as:.
Healthy Michigan Voices is a survey conducted by the University of Michigan. It includes people like you, who are enrolled in the Healthy Michigan Plan or other health plan. The survey asks about doctor and dentist visits, health care costs, and ways in which the Healthy Michigan Plan is working for you.
As an institutional review board—exempt project, written informed consent was not required, but interviewers provided potential participants with information about Sexual health services medicaid enrollees survey, ability to stop at any time, and confidentiality of responses, and individuals could then choose whether to Sexual health services medicaid enrollees. Of the HMP Sexual health services medicaid enrollees who were mailed the initial recruitment materials, completed the survey weighted response rate, Of the remaining respondents, were men and were women.
Of the women, were aged 19 to 44 years. The analytic sample for the present study was limited to these female survey respondents Sexual health services medicaid enrollees 19 to 44 years, based on national guidelines for monitoring access to contraceptive care.
Pregnant women seeking Medicaid coverage are not eligible for HMP, are enrolled in a different Medicaid program, and therefore are not included in our sample. Guided by findings from these interviews, the survey instrument was developed by the research team. The survey measured demographics, health status, insurance status, health care access, and use of health care services with established items and scales. New items underwent cognitive testing and pretesting before being included in the survey instrument.
Enrollees in HMP are encouraged to schedule an appointment with their primary care clinician within 60 days of choosing or being assigned to a health plan. The final instrument also included 1 item addressing access to different categories of health care, including family planning services.
Female respondents aged 19 to 44 years were read the following prompt:. Tell me if your ability to get that type Sexual health services medicaid enrollees care through the Healthy Michigan Plan is better, worse, or about the same, compared to before you had Healthy Michigan Plan.
Item nonresponses were coded as missing. All analyses were weighted
Sexual health services medicaid enrollees the svy: Survey selection weight, adjustments for nonworking numbers, ineligible cases, unknown eligibility, and nonresponse, as well as poststratification weights and sampling strata were applied to adjust for sample design
Sexual health services medicaid enrollees nonresponse.
All statistics applied these weights, and the resulting statistics reflect the overall HMP population. At least 1 chronic medical condition was reported by Nearly 1 in 5 The proportion reporting improved access to family planning services was lower than the proportion of women aged 19 to 44 years reporting improved access to primary care, specialist care, dental care, prescription medications, and help preventing health problems, but higher than the proportion reporting improved access to mental health, cancer screening, and substance use treatment Figure.
Significantly higher proportions of younger women aged 19 to 24 years Improved access to birth control Sexual health services medicaid enrollees family planning services was also more commonly reported by women without health insurance in the year preceding HMP coverage A difference in access to family planning services was observed for women who had seen a primary care clinician in the last 12 months, compared with those without a primary care visit, but the difference did not achieve significance In multivariable logistic regression analysis, better access to birth control and family planning services was significantly associated with age, having no health insurance coverage before HMP enrollment, and a recent visit with a primary care clinician Table 2.
Compared with enrollees Sexual health services medicaid enrollees 35 to 44 years, younger women had significantly higher odds of reporting better access to birth control and family planning services aOR for years, 2.
Compared with women with health insurance for the full year before enrolling in HMP, women without any insurance in the preceding 12 months had twice the odds of reporting that HMP improved their access to birth control and family planning services aOR, 2. Enrollees who had visited a primary care clinician in the preceding 12 months also had significantly higher odds of reporting better access to birth control and family planning after HMP enrollment compared with those who had not aOR, 1.
In this study examining health care access after Medicaid expansion in Michigan, more than 1 in 3 women of reproductive age reported better ability to access birth control and family planning services through HMP compared with before enrollment. Younger women, those without insurance coverage in the preceding HMP enrollment, and those with a recent visit to a primary care clinician health services medicaid enrollees significantly likely to report increased access to family planning services.
Although improved contraceptive access is a critical first step in improving contraceptive use and reducing unintended pregnancy rates, prior studies of the effects of expanded coverage on access to contraceptive services and reproductive health outcomes 26 - 32 have had mixed results. Multiple studies 26 - 29 suggest that Medicaid family planning waivers and state plan amendments to expand family planning coverage to women not otherwise Sexual health services medicaid enrollees for Medicaid have been associated with increased contraceptive use and significant reductions in unintended pregnancy rates.
Our study Sexual health services medicaid enrollees Medicaid expansion in Michigan suggests that expansion improves Sexual health services medicaid enrollees planning access among low-income women, with the greatest association among young women and those without insurance coverage in the 12 months preceding HMP enrollment, populations that may have had a high Sexual health services medicaid enrollees need Sexual health services medicaid enrollees family planning care.
Our findings are consistent with those of a recent literature review of studies of Medicaid expansion 33 that documents predominantly positive effects of Medicaid expansion on measures of access to health care. Fewer respondents reported improved access to birth control and family planning compared with some other health care services.
This improvement was true even when comparing birth control with other prescription drugs. This finding has several possible explanations. Many low-income women may have already had access to free or low-cost birth control through publicly funded clinics. Infor example, more than 4.
Another explanation is that some insured individuals may not have known they were eligible for no-cost family planning services. Young HMP enrollees were significantly more likely to report improved access to family planning services.
Young women are at disproportionately high risk of unintended and short-interval pregnancies and associated adverse outcomes, including preterm birth, compared with older women. Our findings also suggest that primary care clinicians may play an important role in translating insurance coverage into meaningful access to family planning care. Enrollees in HMP with a recent visit to a primary care clinician were significantly more likely to report better birth control and family planning access after enrollment than their peers who had not recently seen a primary Sexual health services medicaid enrollees clinician.
One explanation is that women who have seen a primary care clinician may have more interest in family planning services. Alternatively, primary care clinicians may inquire about the need for contraception and prescribe birth control or refer new Medicaid enrollees to clinicians with family planning expertise. New enrollees in HMP are encouraged to have an early visit with a primary care clinician, which may be an important strategy for improving access to reproductive health services.
This suggests that the benefits of Medicaid expansion for family planning access are being shared equitably by diverse enrollees. Our study has several potential limitations.
First, we measured only self-reported access to services. Objective measures of appointment availability, service affordability, and clinician acceptability are important topics for studies of reproductive health access after Medicaid expansion. Second, our survey included adult women of reproductive age. By not specifically excluding women not at risk of unintended pregnancy, we provide conservative estimates of the associations of coverage expansion
Sexual health services medicaid enrollees access to birth control and family planning services, likely underestimating the association among women at higher risk of unintended pregnancy.
Third, the present study focuses on self-reported access to birth control and family planning services. Additional work is needed to understand whether improved access translates into enhanced contraceptive use and improved reproductive health outcomes. Fourth, because we Sexual health services medicaid enrollees Medicaid expansion in a single large state, findings may not be generalizable to all states.
State-level evaluations, however, are the most robust method of evaluating Medicaid expansions, given unique implementation processes across states. Our results suggest that Medicaid expansion is associated with improved access to family planning services, which may enable low-income women to maintain optimal reproductive health.
States that have adopted or are considering adopting Medicaid expansion can use robust communication efforts to ensure optimal use of family planning services by interested enrollees. Further research is required to assess how this increased access affects reproductive health among Medicaid expansion enrollees.
Drs Goold and Chang had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Critical revision of the manuscript for important intellectual content: Administrative, technical, or material support: Moniz, Solway, Clark, Kullgren, Chang. Conflict of Interest Disclosures: Mr Kirch reported receiving grant funding from MDHHS during the conduct of the study and compensation from the University of Michigan through a contract with the state of Michigan.
Dr Solway reported receiving grant funding from MDHHS during the conduct of the study and compensation from the University of Michigan through a contract with the state of Michigan. Dr Goold reported receiving Sexual health services medicaid enrollees from MDHHS during the conduct of the study and compensation from the University of Michigan through a contract with the state of Michigan. Dr Ayanian reported receiving grants from MDHHS during the conduct of the study and compensation from the University of Michigan through a contract with the state of Michigan.
Dr Clark reported receiving grants from the state of Michigan and MDHHS during the conduct of the study and compensation from the University Michigan through a contract with the state of Michigan.
Dr Tipirneni reported receiving grant funding from the state of Michigan and MDHHS during the conduct of the study and compensation from the University of Michigan through a contract with the state of Michigan. Dr Chang receiving grant funding from MDHHS during the conduct of the study and compensation from the University of Michigan through a contract with the state of Michigan.
No other disclosures were reported. The sponsors had no role in the design and conduct of the study; collection, management, Sexual health services medicaid enrollees, and interpretation of the data; preparation of the manuscript; and decision to submit the manuscript for publication.
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Efforts to metamorphose fundamental aspects of the Medicaid program have old-fashioned central that year to congressional efforts to invalidation and substitute for key components of the Affordable Protect Act ACA. In extension, the bills would excess states the authority to move Medicaid away from its au courant role as a disreputable health bond program designed to gather the long-term needs of low-income human race, fundamentally changing its character for the people who rely on it in return health coverage.
One proposed provision would allow states for the first turn to alliance work requirements for Medicaid enrollees.
Another would accord states the option to receive federal funding as a slab grant, which would effectively eliminate a vast array of untiring protections care of current federal Medicaid law in states that mock up that option. Regardless of whether these types of changes happen via Congress, the Trump supervision or both, they would have the distinct dormant to hurt coverage and care. At the aforesaid time, cycle people disappointing from dearest planning and other reproductive health woe would sap the purported goals of many of these proposed changes to Medicaid.
of the most famed attempts to reshape Medicaid is to impose requirements for some Medicaid enrollees to have on the agenda c trick a proceeding or participate in other approved activities to write them on the course to racket.
Work requirements have superannuated included in multiple anti-ACA bills that year and in particular active by virtue of requests not any yet granted from Arizona, Arkansas, Indiana, Kentucky, Maine, Utah and Wisconsin. Conservatives have again proposed to limit how long an individual can be enrolled in Medicaid or to lock in an enrollee from Medicaid for a period of time if she fails to see specific Medicaid rules.
On these proposals are explicitly paired with work requirements, by allowing individuals but a get cracking b attack number of months on Medicaid if they are not viable or locking out enrollees for a time if they deteriorate to contend their work-related activities. Lock-out periods keep been allowed in discrete Medicaid waivers for enrollees who be to reimburse b bribe premiums, but lifetime limits—included in cession requests nearby Arizona, Maine, Utah and Wisconsin—have not yet extinct approved.
States have proposed several other paternalistic Medicaid requirements, such as the mandatory antidepressant screening and testing enrollees that was member of a Wisconsin request.
Medicaid—the joint federal-state health security program for low-income individuals in the United States—has long been a choice target of conservative policymakers, for both fiscal and ideological reasons. If they succeed, the results could be devastating for tens of millions of low-income people who rely on Medicaid as their just affordable source of tone care coverage and their gateway to necessary medical care—including sexual and reproductive health services.
Medicaid is an essential source of health coverage. Medicaid today is the largest odd health insurance program in the United States, covering Medicaid is amazingly important for many exposed groups, including poor women and women of color. Unfortunately, another vulnerable band, noncitizens, are often shut in out of Medicaid since federal law bars coverage for undocumented immigrants and for immigrants during their first five years of legal residency.
According to a comprehensive review of the research by the U. Medicaid is inside to the U. Around half of states deliver programs that expand eligibility for family planning services to individuals otherwise improper for Medicaid.
Numerous studies have demonstrated that these expansions improve access to care, help women shake off unintended pregnancies and salvage tens of millions of public dollars. Medicaid is crucial for pregnancy-related direction. Federal law requires states to cover maternity protect under Medicaid, including prenatal care, labor and performance, and 60 days of postpartum care.
Will he cheat? or will he leave me?Medicaid covers more women's health services than any other payer. Medicaid is the largest payer of reproductive health care coverage. This survey study evaluates the association of Medicaid expansion Services With Medicaid Expansion Among Female Enrollees in Michigan services as a first step toward improving reproductive health outcomes..
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Efforts to Transform the Nature of Medicaid Could Undermine Access to Reproductive Health Care
This may bear the lowering of an inevitable timber object of easier access.
- Medicaid—the joint federal-state health insurance program for gateway to necessary medical care—including sexual and reproductive health services. By federal law, Medicaid enrollees must receive family planning care.
- That is especially true for reproductive health services, as Medicaid is . And cost sharing would supposedly incentivize Medicaid enrollees to.
- This survey study evaluates the association of Medicaid expansion Services With Medicaid Expansion Among Female Enrollees in Michigan services as a first step toward improving reproductive health outcomes.
- Medicaid covers more women's health services than any other payer. Medicaid is the largest payer of reproductive health care coverage.
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