Connecticut Family Planning Expansion and Effect on IUD Adoption. Susan Lane, Planned Parenthood of Southern New England, Inc.

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1 Connecticut Family Planning Expansion and Effect on IUD Adoption Susan Lane, Planned Parenthood of Southern New England, Inc.

2 Disclosure I have no actual or potential conflicts of interest in relation to this presentation. 2

3 Why we need Medicaid Family Planning expansion Each year in the US publicly funded family planning services help women prevent nearly 2,000,000 unintended pregnancies, including almost 400,000 pregnancies among teenagers. Preventing these pregnancies results in 860,000 fewer unintended births, 810,000 fewer abortions and 270,000 fewer miscarriages. Avoiding the significant costs associated with these unintended births saves taxpayers close to $4 for every $1 spent on family planning. The Guttmacher Institute

4 Connecticut Family Planning Limited Benefit Program (FPLB) CT General Assembly passed bill in 2007 directing the Department of Social Services (DSS) to apply to Centers for Medicaid and Medicare, (CMS), for a Family Planning Waiver. DSS began offering coverage in March of State Plan Amendment made possible under ACA. Intended for the prevention of pregnancy and the spacing of children. 4

5 FPLB Eligibility US citizen or registered alien, Connecticut resident. Uninsured or high deductible plan. Income is at or below 250% of the Federal Poverty Level. Family of one: $28,700 year; family of three: $48,800 Women and men of reproductive age.

6 FPLB Covered Services Family planning services and supplies. All FDA approved contraceptive methods, including IUDs and hormonal implants. Other services provided as part of family planning: STD testing and treatment, Pap testing, colposcopy, cryosurgery But only as part of family planning visit.

7 Point of Service sign up Providers can become Certified Entity Allows for providers such as PPSNE to grant Presumptive Eligibility (PE). PE voucher active for 10 days. Ongoing coverage determined by DSS yearly renewal. Initial visit covered even if patient is denied ongoing coverage status. DSS may determine patient is eligible for full Medicaid benefits.

8 number of applications Growth of FPLB program in year one PPSNE Medicaid Family Planning cumulative sign ups 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, Monthly totals include estimate of those who obtained full XIX benefits PPSNE has submitted nearly 4,000 applications to date Started off slowly and began build over the summer. Our goal is to sign up either new or renewal 125 individuals a week.

9 Where FPLB applicants eventually land Two thirds of patients who sign up for the Medicaid FPLB end up getting a full year of FPLB coverage. Nearly one-fourth are awarded full Medicaid benefits, such as LIA or Husky plans. PPSNE patients who applied for FPLB April 2012 to March 2013 Full Medicaid, 23% Self Pay, 8% Commercial 2% FPLB, 67% A small percent eventually obtain commercial insurance.

10 FPLB drives increase in LARC use Use of Long Acting Reversible Contraception (LARCs) among PPSNE patients is up 35% in the last year. This includes IUDs and hormonal implants. Much of the increase is driven by patients who signed up for FPLB. IUD use among Medicaid patients jumps 60% between July and August 2012 the same time FPLB program applications doubled (as a result of clarifications in DSS rules).

11 # of IUDs FPLB drives increase in LARC use IUD insertions by payer type: PPSNE patients FPLB applications doubled between July and August, due to clarifications in DSS rules. Medicaid (all plans) Commercial Self pay

12 Conclusions FPLB program has so far been effective in getting many young adults into full benefit Medicaid programs, which could lead to overall improvement in preconception health and birth outcomes. FPLB program appears to be driving an increase in IUD use, which could significantly reduce public $$ spent on unintended pregnancies. PPSNE experience supports other research showing that when cost is not a factor, women often choose more effective LARC methods.

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