| The Medicaid program is the largest source of public funding for family planning programs, providing half of all public dollars spent on contraceptive supplies and services. The implementation of Medicaid managed care programs has changed the delivery system. This research contributes to our understanding of this issue by analyzing the experiences of Medicaid recipients in Baltimore, Maryland who receive family planning services in a mandatory Medicaid managed care system. Qualitative data were collected from Medicaid recipients at clinic and non-clinic locations and analyzed using Atlas ti software. An analysis of providers shows no increase of private physicians new to serving the Medicaid population through the managed care program; recipients are heavily dependent on the safety net providers who have traditionally served the Medicaid population. Data indicate that the majority of recipients, 68%, seek family planning services from their usual source of care for several reasons: to maintain continuity of care, location, the ability to get appointments quickly, recommendations from family and friends, and services offered. For the 17% of recipients who chose other than their usual source of care, reasons included: not being able to get a timely appointment at their usual source of care, confidentiality, staff, and services provided. The managed care system works well for women who are enrolled in regular Medicaid and routinely seek care at clinics where there is an focus on reproductive health. Knowledge of the Family Planning Exemption, which allows recipients to seek contraceptive care from any qualified provider, was poor at all clinic sites; 65% of recipients did not know about the Exemption. This lack of knowledge was problematic and created access barriers for recipients who attempted to seek care outside of their primary clinic. Recipients who transitioned off of regular Medicaid coverage and were eligible for the Family Planning Expansion waiver program reported barriers to enrollment in this program. While rates of having ever discontinued a contraceptive method were similar at all sites, the non-clinic sites or clinic sites not focusing on reproductive health had a much higher proportion of recipients who were not contracepting and exposed to an unintended pregnancy. |
