Quantifying the Contraception Workforce and Access Landscape in National Medicaid Data

• In Event: Evaluating Policies to Improve Access to Contraception in the US

Abstract

Introduction
Access to contraception services is an essential component of reproductive autonomy; however, low-income individuals frequently face barriers to care, including a shortage of providers who both accept Medicaid and offer contraception services. Although national Medicaid data are of wide interest to policy researchers there are no established methods to measure the range of clinicians who provide contraception services and where they are located. 
Research Objective
Using a national Medicaid claims dataset, we studied the specialty and geographic distribution of the workforce providing contraception to Medicaid beneficiaries in 2021 to better understand factors affecting access to contraception care for low-income individuals.
Methods
We used 2021 Transformed Medicaid Statistical Information System (T-MSIS) data, a national dataset that includes enrollment, service utilization, and claims for Medicaid and Children's Health Insurance Program enrollees. Using claims to identify providers of services, we then identified clinician specialties by linking National Provider Identifiers (NPIs) in T-MSIS to the National Plan & Provider Enumeration System (NPPES). We included the most common clinician types providing contraception (OBGYNs, family medicine physicians, internal medicine physicians, pediatricians, nurse practitioners, midwives, and physician assistants). Our five outcome measures were: (1) number of clinicians who provided at least one contraception method to Medicaid beneficiaries; (2) number of clinicians who provided all three method categories to Medicaid beneficiaries (referred to as “a wide range of methods” throughout this study); (3) proportion of each group in outcomes 1 and 2 that were OBGYNs, family medicine physicians, internal medicine physicians, pediatricians, nurse practitioners, midwives, and physician assistants; (4) proportions of Medicaid-accepting clinicians within each specialty who provided at least one contraceptive method (eg, proportion of OBGYNs who provided one contraceptive method to Medicaid beneficiaries out of all OBGYNs who provided any care to Medicaid beneficiaries of reproductive age) and who provided a wide range of contraceptive methods (eg, proportion of OBGYNs who provided a wide range of contraceptive methods to Medicaid beneficiaries out of all OBGYNs who provided any care to Medicaid beneficiaries of reproductive age); and (5) per-county clinicians counts for advanced practice clinicians compared with physicians.
Results
We identified 523 077 primary care and women's health specialty clinicians (obstetrician–gynecologists, family medicine, internal medicine, pediatrics, nurse practitioners, physician assistants, and midwives) who provided care to reproductive aged (15–44 years) female Medicaid beneficiaries for any service; of these, only 181 019 (34.6%) provided at least one contraception method to Medicaid beneficiaries and even fewer 20 160 (3.9%) provided prescriptions (pill, patch, and/or ring), IUDs, and implants. Over half (54%) of US counties had greater or equal numbers of advanced practice clinicians—nurse practitioners, physician assistants, and midwives—prescribing contraception compared with physicians.
Conclusion
Few clinicians provided a wide range of contraception to Medicaid beneficiaries. Advanced practice clinicians are important providers in counties with limited access to physicians. Documenting workforce variation for contraception care has important implications for access, especially as recent policy changes may make contraception less accessible for Medicaid beneficiaries.

Author

• Julia Strasser, George Washington University
  Presenting Author