Role of medicaid family planning waivers and Title X in enhancing access to preconception care.

PURPOSE: This article identifies the ways in which Medicaid eligibility expansions for family planning services and the Title X network of family planning clinics provide opportunities to introduce preconception care. The introduction of family planning eligibility expansions brought in populations heretofore ineligible for Medicaid. Family planning clinics serve a large number of low-income and young women and would play an important part in introducing preconception care. However, very real barriers to preconception service provision need to be addressed before this goal can be fully realized.

BACKGROUND: When established in 1965, Medicaid, by and large, covered low-income women and their children receiving welfare. A succession of Medicaid eligibility expansions for pregnancy-related care broke the link with welfare. More recently, expansions implemented in 20 states have created an eligibility pathway to Medicaid coverage for women before pregnancy. Today, whether as part of a Medicaid family planning program or independently, many women receive family planning services through the nation's system of publicly funded clinics. As the nation's only dedicated source of funding for family planning services, Title X supports a nationwide network of family planning clinics on which young women rely for affordable and confidential reproductive care.

DISCUSSION: Working preconception care into the existing family planning and pregnancy care programs would create a single, continuous reproductive health care platform. Family planning clinics could introduce preconception health measures to the young women who rely on them for their reproductive health care. Important barriers to rolling out preconception care still exist, however. For family planning providers to integrate the services into their current practices, a definition of the package of services that is realistic to provide in a family planning setting must be crafted. In addition, securing a stable funding stream is a necessary prerequisite to any large-scale integration of preconception care into family planning settings. Finally, attention needs to be given to ways to talk to predominantly young clientele about preparing for a pregnancy at the moment when they are coming in for services precisely to avoid becoming pregnant.

CONCLUSION: Despite the challenges laid out, integrating preconception care into family planning services is achievable. Combining preconception care with family planning and pregnancy care initiatives would be a significant step in moving the country closer to the goal of providing the comprehensive reproductive health care women need.