title: Extending Medicaid coverage for family planning services: Alabama's first four years.
abstract: OBJECTIVE
  This study examines whether Alabama's Medicaid family planning demonstration program reaches a different segment of the population than the health department-based Title X family planning program, whether service use rates differ across clients using care within and outside of the Title X provider system, and whether additional risk assessment and care coordination services provided by health department personnel increase the likelihood that family planning clients return for follow-up visits over time.
  
  
  METHODS
  Administrative data from four years of operation of the program were used to examine characteristics of the clientele, differences in services used across provider types included in the program, and the impact of risk assessments and care coordination on return visit rates.
  
  
  RESULTS
  The number of family planning service users increased dramatically over the four-year period, but were more similar demographically to Title X clients than to Medicaid maternity clients. Growth was greatest among clients of non-Title X providers. Newly covered services, including risk assessments and care coordination, were available mostly to Title X clients, and these services were associated with a greater likelihood that clients returned for care in subsequent years.
  
  
  CONCLUSIONS
  Expanded provider networks can increase the number of low income women using family planning services while risk assessment and care coordination can improve the effectiveness of these services. However, enhanced services may not be equally available across provider systems. Additional outreach efforts are needed to reach women eligible for publicly supported family planning services who are not currently using these services.
authors.affiliation: School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294-0022, USA. jbronste@uab.edu
authors.forename: Janet M
authors.initials: JM
authors.lastname: Bronstein
authors.forename: Annie
authors.initials: A
authors.lastname: Vosel
authors.forename: Shery K
authors.initials: SK
authors.lastname: Georsel
authors.forename: Charlena
authors.initials: C
authors.lastname: Freeman
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Payne
mesh_terms: D000328:Adult; D000407:Alabama; D003266:Continuity of Patient Care / Q000191:economics; D004608:Eligibility Determination; D005193:Family Planning Services / Q000191:economics* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008484:Medicaid / Q000639:trends*; D009936:Organizational Innovation; D010865:Pilot Projects; D011203:Poverty; D016730:Program Development; D015397:Program Evaluation; D011635:Public Health Administration; D018570:Risk Assessment / Q000191:economics; D014481:United States