Medicaid is the primary source of family planning coverage in the United States, accounting for 75 percent of total public expenditures for family planning services; Title X and state and local governments also play an important role, including by financing family planning services for individuals who otherwise lack coverage.
This toolkit reviews the policy options available to state Medicaid agencies seeking to ensure that Medicaid enrollees have access to the full range of family planning services and supplies. Before turning to these policy options, this introduction sets out baseline information about the efficacy of family planning and the importance of assuring that enrollees have free choice about whether to use contraception and the method(s) they use.
Importance of Family Planning
According to Healthy People 2020, family planning is one of the 10 great public health achievements of the 20th century, allowing individuals to achieve desired birth spacing and family size, and contributing to improved health outcomes for infants, children, women, and families. Healthy birth spacing, for example, helps reduce the number of babies born prematurely, at low birth weight, or small for their gestational age. In addition to maternal and infant health benefits, family planning has social and economic benefits. For example, research shows that contraception allows women to complete their educations and pursue careers, resulting in contributions to the economy and reducing public expenditures related to unintended pregnancies.
Family planning also serves an important role in connecting women to healthcare. For many women, a family planning provider is their entry point into the healthcare system and their usual source of care.
Over time, the number and types of contraception available to women in the United States have grown— and the effectiveness of the options available to women has increased. The reasons that individuals choose some methods over others vary, and are impacted by multiple factors including age, partnership or relationship status, fertility desires, and insurance coverage. Research demonstrates that most women rely on multiple contraceptive methods throughout the course of their lives,6 and that women have diverse and strong preferences when selecting a particular method of contraception.7 For some women, effectiveness of a method is a primary concern. Figure 1 below categorizes the range of available contraceptive methods by level of effectiveness. Depending on the method, contraceptive effectiveness ranges from 18 or more pregnancies per 100 women in a year (for methods like withdrawal and the sponge) to less than one pregnancy per 100 women in a year (for methods like intrauterine devices (IUDs) and the contraceptive implant—collectively referred to as long-acting reversible contraceptives (LARCs)).