Surveys of state Medicaid agencies and maternal and child health programs were conducted in late 1991 and in 1992 to evaluate the extent to which states carried out a series of federal policy changes intended to improve low-income women's access to prenatal care. The results show a great deal of variability in the aggressiveness with which states implemented these Medicaid eligibility expansions. Overall, North Carolina, Maryland, Massachusetts, New York and Arkansas moved most aggressively to carry out the expansions; Kansas, Nebraska, South Dakota, North Dakota and Wyoming were ranked least aggressive. States with relatively high levels of poor birth outcomes or low-birth-weight deliveries prior to the Medicaid expansions were generally more likely than other states to have undertaken reforms intended to increase the number of women eligible for assistance and ease their enrollment. In addition, expansion efforts were greater in states where the federal government paid more of the cost of caring for Medicaid recipients.

Eligibility Determination↗

PubMedDate not supplied

Public funding for contraceptive, sterilization and abortion services, fiscal year 1992.

In 1992, the federal and state governments spent $645 million to provide contraceptive services. According to the results of a survey of health, social service and Medicaid agencies conducted by The Alan Guttmacher Institute, Medicaid accounted for 50% of all public spending on family planning services. State governments, which spent a total of $155 million of their own revenues for contraceptives services, accounted for 24% of public funding, Title X for 17%, and the social services and maternal and child health block-grant programs for nearly 10%. Medicaid expenditures for contraceptive services increased dramatically between 1990 and 1992, and were responsible for a 28% rise in total expenditures for contraceptive services during that period. However, when inflation is taken into account, total public expenditures for contraceptive services have decreased by 27% since 1980, and Medicaid has replaced Title X as the primary source of funding for such services. The federal and state governments together spent $138 million to subsidize sterilization services in 1992, an increase of 46% from 1990. The federal and state governments also spent $80 million to provide 202,622 abortions to poor women; less than 1% was contributed by the federal government. These estimates of expenditures are approximations that, because of methodologic problems and changes over time, may overstate public expenditures for contraceptive services.

Abortion, Legal↗

PubMedDate not supplied

Public funding for contraceptive, sterilization and abortion services, 1994.

In 1994, federal and state funding for contraceptive services and supplies reached +715 million. Funding totaled +148 million for contraceptive sterilization and +90 million for abortion services. According to a survey of state health, Medicaid and social service agencies, reported spending on contraceptive services and supplies increased by 11% between 1992 and 1994. In the same period, spending under Title X rose by 37%, making it the third largest public funding source for contraceptive services and supplies. The largest source of public funds for family planning services continues to be the joint federal-state Medicaid program. Medicaid family planning expenditures increased by only 4% between 1992 and 1994, a sizable decrease in growth from previous years. State funds continue to be the second largest source, providing almost one-quarter of reported public expenditures in 1994. The maternal and child health and social services block grants remain relatively minor sources of support nationally, although in a handful of states they provide the majority of public-sector funds. State governments were virtually the sole source of public support for the 203,200 abortions provided in 1994 to low-income women. Despite the loosening of federal abortion funding criteria in FY 1994 permitting payment in cases of rape and incest, federally funded abortions numbered only 282.

Abortion, Legal↗

PubMedDate not supplied

Mainstreaming contraceptive services in managed care--five states' experiences.

CONTEXT: The ongoing, rapid national transition from a health care financing and delivery system dominated by traditional indemnity insurance to one dominated by managed care has enormous implications for the accessibility of contraceptive services. METHODS: In each of five areas with relatively mature managed care environments (all of Colorado, Massachusetts and Michigan, as well as selected counties in California and Florida), all managed care organizations serving commercial or Medicaid enrollees were asked about their coverage of contraceptive services and the procedures for obtaining that care. In addition, all publicly funded family planning agencies in these areas were queried about their involvement with managed care plans, and representative samples of reproductive-age women at risk of unintended pregnancy and enrolled in managed care plans were asked about their plan's coverage and their experiences in obtaining contraceptive services. RESULTS: Fifteen percent of health maintenance organizations and point-of-service plans did not cover all five of the most commonly used medical contraceptive methods, and another 6% covered none of the methods. Only half the plans informed enrollees--and even fewer informed enrollees insured indirectly as dependents--of whether they covered contraceptive services. One in four women in commercial plans were unsure whether their plan covered oral contraceptives, and two in three did not know if their plan covered the other medical methods. Only one in four commercial plans have brought community-based family planning providers into their networks, and more than half of all publicly funded family planning agencies reported having no contracts with managed care organizations. Finally, nearly one in three women in managed care plans reported difficulties in obtaining contraceptive services, with 13% of enrollees in commercial plans waiting at least four weeks for an appointment for contraceptive care. CONCLUSIONS: To adequately address the contraceptive needs of their employees, employers must ensure that the health insurance plans they purchase provide adequate coverage of contraceptive methods. For their part, managed care organizations and state Medicaid programs should examine their policies and procedures to ensure that services are easily accessible to women needing contraceptive care.

Adolescent↗