Claims for Contraceptive Care Among Female Youth Living in Foster Care by Type of Medicaid Insurance: An Analysis of Michigan's Medicaid Claims Data

This study aimed to observe contraceptive access, including types of contraceptives and level of use, among girls and young adults living in foster care following a state policy insurance change. This cohort study utilized linked, state administrative data to analyze child welfare and Medicaid claims data of 1641 female foster youth in Michigan. Oral tablets with a supply of 30 days before exhaustion was the most frequently prescribed contraceptive (77%), while injections, implants, and intrauterine devices (IUDs) that have longer periods of use before exhaustion were rarely prescribed. Longer-term use products were prescribed with decreased frequency in the Medicaid Health Maintenance Organization (HMO) period than in the Medicaid Fee for Service (FFS) period. Foster youth placed in residential care experienced greater access to contraceptive care than those placed in family-based settings (Adjusted Odds Ratio = 0.63, 95% CI = (0.56-0.72)) and those living independently (Adjusted Odds Ratio = 0.55, 95% CI = (0.48-0.64)). Those in the largest urban county had less access (Adjusted Odds Ratio = 0.81, 95% CI = (0.71-0.92)) to contraceptives than those from other counties in the State. Implications for policy and practice are discussed.