$4 Saved for Every $1 Invested; Expanding Medicaid Services to More Low-Income Women Would More Than Pay for Itself

By providing millions of young and low-income women access to voluntary contraceptive services, the national family planning program prevents 1.94 million unintended pregnancies, including almost 400,000 teen pregnancies, each year. These pregnancies would result in 860,000 unintended births, 810,000 abortions and 270,000 miscarriages, according to a new Guttmacher Institute report.

Absent publicly funded family planning services, the U.S. abortion rate would be nearly two-thirds higher than it currently is, and nearly twice as high among poor women.

Publicly funded family planning services are highly cost-effective. More than nine in 10 women receiving them would be eligible for Medicaid-funded prenatal, delivery and postpartum care services if they became pregnant. Avoiding the significant costs associated with these unintended births saves taxpayers $4 for every $1 spent on family planning.

“The national family planning program is smart government at its best,” says Rachel Benson Gold, the study’s lead author. “Publicly funded family planning is basic health care that empowers disadvantaged women to decide for themselves when to become pregnant and how many children to have. It reduces recourse to abortion. And it saves significant amounts of taxpayer money.”

More than nine million women received publicly funded contraceptive services in 2006. Most (7.2 million) received their care from the national network of family planning centers. Another two million women received Medicaid-funded family planning care from private doctors. Six in 10 women who get care at a family planning center, including three out of four who are poor, consider the center to be their usual source of health care, according to the report.

“Many low-income women get their basic health care for the year during an annual visit to a family planning center,” says Gold. “The package of services they receive not only includes contraceptive counseling and the provision of a contraceptive method. It also includes pelvic and breast exams, tests for HIV and other STIs, screenings for reproductive cancers, high blood pressure and diabetes, and referrals to other health providers when necessary. This is essential, preventive health care for disadvantaged women.”

Public expenditures for family planning in 2006 totaled $1.85 billion, with 71% of those funds coming from the joint federal-state Medicaid program. The role of Medicaid in funding family planning has risen dramatically since the 1980s. The increase was driven by efforts in 21 states to expand eligibility specifically for family planning for low-income women who otherwise would not qualify for Medicaid.

“States as varied as Texas, New York, South Carolina and Missouri have decided to undergo the cumbersome and time-consuming process to seek federal permission, known as a waiver, to expand family planning services to more women who need them,” says Gold. “It’s a popular policy because it helps women while saving public dollars. It more than pays for itself.”

The report recommends that Congress eliminate the waiver requirement. Instead, states should be allowed to use the same income criteria to determine eligibility for family planning under Medicaid that they use to determine eligibility for pregnancy-related care.

“Cutting through the red tape and doing away with the waiver is a crucial first step that should be a high priority for policymakers,” says Gold. “Our report recommends other policy changes to help the national family planning program maintain and increase its effectiveness. These include increased funding for the federal Title X program, which provides critical support to the national family planning provider infrastructure. Policymakers also need to take a more comprehensive look at how Medicaid and Title X can best complement and strengthen each other.”

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Next Steps for America’s Family Planning Program: Leveraging the Potential of Medicaid and Title X in an Evolving Health Care System

Facts on publicly funded contraceptive services in the United States