Teen Pregnancy

PSR NATIONAL SUMMARY

The Prevention Status Reports highlight—for all 50 states and the District of Columbia—the status of public health policies and practices designed to address 10 important public health problems and concerns. This report highlights the status of a key policy that states can use to reduce teen pregnancy: increasing access to contraceptive counseling and services by expanding the age and income eligibility levels for Medicaid coverage of family planning services to increase teens’ access to healthcare services, including contraception and other preventive services.

Prior to the Affordable Care Act (ACA), women qualified for full Medicaid coverage only if their incomes were very low and they belonged to one of Medicaid’s categories of eligibility—parent, senior, or disabled. Pregnant women were eligible for prenatal, delivery, and newborn care at a somewhat higher income level but generally lost coverage soon after delivery. Since the 1990s, many states have broadened Medicaid eligibility for family planning services and supplies for people who were not otherwise eligible for Medicaid (1). Many states offered family planning services to women at higher income levels through waivers applied for and granted by the Centers for Medicare and Medicaid Services (CMS). The ACA included an option for states to expand full Medicaid services to individuals based on income eligibility alone. Another ACA provision allowed states to make coverage for family planning services available at the same income level as for pregnancy care through a state plan amendment (2–7). Thus, states have three options to provide Medicaid coverage for family planning services to low-income individuals. Income-based Medicaid expansions have been shown to be effective in reducing births among teens aged 15–19 years (2–5).

States can expand access to their Medicaid family planning program and reduce teen births by 1) extending coverage to teens under age 18 years and 2) setting the income eligibility level for family planning coverage to at least the same income level required for pregnancy care coverage (this level varies by state). Expanding Medicaid coverage for family planning services is consistent with US Department of Health and Human Services recommendations to support reproductive and sexual health services (8) and with Healthy People 2020 family planning objectives (9). Other strategies for reducing teen pregnancy that are supported by scientific evidence include providing sexual health education for adolescents, using positive youth development approaches, and improving parent-child communication and parental monitoring of youth behavior (10–13).

Expansion of state Medicaid family planning eligibility

State expansion of eligibility for Medicaid coverage of family planning services to include teens under age 18 years and to be set to at least the income eligibility level for coverage of pregnancy care (this level varies by state).

How These Ratings Were Determined
These ratings reflect the extent to which each state had expanded eligibility for Medicaid coverage of family planning services. A review of state Medicaid family planning waivers and state plan amendments (SPAs) was conducted to determine whether each state’s income eligibility level for family planning coverage was set to at least the same income level as for pregnancy care coverage (14,15). The income eligibility level for family planning services extended to applicants whose income was up to 5 percentage points above the set FPL for the following states: Alabama, Connecticut, Indiana, Louisiana, Mississippi, Missouri, Montana, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, South Carolina, Virginia, and Wisconsin. This review also examined the extent to which state waivers or SPAs covered all teens, regardless of pregnancy status (14). In addition, a review was conducted of those states that had expanded their Medicaid programs under the ACA to cover adults aged <65 years with incomes up to 138% of the FPL (16). Teens aged ≤18 years with family incomes up to 138% of the FPL (or higher, depending on the state) are eligible for free or low-cost health coverage, including family planning services, in all states that have expanded Medicaid.

**State count includes the District of Columbia