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Medicaid Expansion at Title X Clinics

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Background:

Title X supports access to family planning and preventive care services. Given its focus on low-income clients, Title X clinics may have been particularly affected by the Affordable Care Act’s Medicaid expansion.

Objectives:

To examine the impact of the Affordable Care Act’s Medicaid expansion on Title X client volumes, health insurance coverage, and contraceptive method mix.

Research Design:

A difference-in-differences design compared changes in the outcomes of interest before and after expansion, for expansion versus nonexpansion states.

Subjects:

Administrative data from Family Planning Annual Reports that describe Title X clients who sought services.

Measures:

Female client volume was measured using a participation ratio defined as the number of female clients per 100 women aged 15–44 with incomes <250% of the federal poverty line. We also examined the share of clients by insurance type and contraceptive method type.

Results:

We did not find evidence that expansion was related to changes in client volume. We did find a significant 9.9 percentage point increase in the share of clients with Medicaid and a significant 10.0 percentage point decrease in the share of clients without coverage. We found suggestive evidence that expansion was associated with increased use of long-acting reversible contraceptives, but those results were somewhat sensitive to model specification.

Conclusions:

Expansion was associated with meaningful increases in Medicaid coverage at Title X clinics and declines in uninsurance. Our results have important implications for the financial stability of Title X clinics in light of historical declines in Title X grant revenues.
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Keywords: Family Planning; Medicaid; Title X

Document Type: Research Article

Affiliations: School of Public Health, University of Maryland, College Park, MD

Publication date: June 1, 2019

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