Washington state takes charge with new program
Washington state takes charge with new program
A new program in Washington state is helping men and women with incomes at or below 200% of the federal poverty level to take charge of their lives by providing them with family planning services before pregnancy occurs.
The Take Charge program is the state’s Medicaid demonstration and research program. Since the program was implemented in July 2001, 26,000 men and women had enrolled at press time, with an average number of 5,500 new enrollees per month, says Mary Neukom, family planning program manager with the Department of Social and Health Services Medical Assistance Administration in Olympia.
Washington state’s pregnancy risk assessment monitoring system research indicates that 60% of births to Medicaid-eligible women were unintended at the time of conception, states Neukom. The Take Charge program is designed to provide pre-pregnancy family planning. Without the program, family planning services are offered after a pregnancy occurs for women with family incomes up to 185% of the federal poverty level, Neukom points out.
"This exciting new program seems to be self-promoting, as there has been a steady increase in men and women seeking Take Charge family planning services," Neukom observes.
Focus on waivers
Since 1993, 14 states received approval from the federal government for demonstration projects allowing them to expand Medicaid coverage of family planning services under waivers of Section 1115 of the Medicaid statute. States with such waivers in place include Alabama, Arizona, Arkansas, California, Delaware, Florida, Maryland, Missouri, New Mexico, New York, Oregon, Rhode Island, South Carolina, and Washington. (See the Washington Watch column in the December 2001 issue of Contraceptive Technology Update, for an overview of these programs.)
The programs vary in their eligibility criteria, with the earliest of these waivers allowing states to provide family planning services to low-income women enrolled in Medicaid for up to five years following the birth of a child, rather than the traditional 60-day postpartum period. More recent waivers allow states to provide family planning services to any woman with an income up to 200% of poverty, such as is the case in Washington state.
Cover all the bases
The Take Charge program covers:
- an annual exam including education, counseling, and risk reduction component;
- all Food and Drug Administration-approved prescriptive contraceptive methods, devices, and supplies;
- over-the-counter contraceptive products such as male and female condoms, contraceptive cream, foam, film, gel, and suppositories;
- sterilization (vasectomy or tubal ligation).
Marketing of the program has been successful due to word of mouth and support of community organizations and state agency partnerships such as Head Start, Child Support, health departments, pharmacy and medical associations, health care plans, and family planning providers, says Neukom. To get the message out, the program uses printed materials, including a client flier, wallet card, and bookmark; a toll-free hotline number [(800) 770-4334]; and information on the web (http://maa.dshs.wa.gov/familyplan), including a client worksheet and application.
The Take Charge program has received an enthusiastic response from King County residents, with close to 2,000 clients applying through the county’s public health clinics during its first two months. Maria Wood with the Family Planning Program at the Seattle-based Public Health — Seattle and King County says her agency is focusing Take Charge enrollment within its existing patient population, since seven out of 10 of family planning visits involve uninsured patients who are eligible for the program. The agency also is working with some of its community partners to refer patients to Take Charge providers or consider becoming Take Charge provider organizations, says Wood.
"Providers have been oriented in terms of the Take Charge program and the family planning services it covers," reports Wood. "Also, we have trained providers on the other services covered by the program, such as education, counseling, and risk reduction intervention."
Planning is effective
According to information from the New York City-based Alan Guttmacher Institute, Medicaid waiver programs have been effective in averting unintended pregnancies. For example, California’s program enabled 108,000 women, including 24,000 teens, to avoid an unintended pregnancy in fiscal years 1998 and 1999. This prevented 41,000 abortions, including 9,000 abortions to teens. Such action averted $511.8 million in public expenditures for medical care and social services, or $4.48 for every dollar spent on the program. In similar actions, Oregon’s waiver program averted 7,170 pregnancies in 2000, saving $16.6 million in anticipated public expenditures.1
Effective family planning is the best way to avoid unintended pregnancies, and the Take Charge program allows large numbers of women and men to have access to a range of family planning services.
"Budget estimates are a combination of family planning and maternity expenditures with the expectation that at the end of the five-year waiver, the additional family planning expense is offset by decreased maternity cost," says Neukom.
Reference
- Alan Guttmacher Institute. Medicaid Family Planning Waivers. New York City; July 2001.
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