title: Financial effect of instituting Deficit Reduction Act documentation requirements in family planning clinics in Oregon.
abstract: BACKGROUND
  The study was conducted to estimate the long-term costs for implementing citizenship documentation requirements in a Medicaid expansion program for family planning services in Oregon.
  
  
  METHODS
  A decision-analytic model was developed using two perspectives: the state and society. Our primary outcome was future reproductive health care costs due to pregnancy in the next 5 years. A Markov structure was utilized to capture multiple future pregnancies. Model inputs were retrieved from the existing literature and local hospital and Medicaid data related to reimbursements. One-way and multi-way sensitivity analyses were conducted. A Monte Carlo simulation was performed to simultaneously incorporate uncertainty from all of the model inputs.
  
  
  RESULTS
  Screening for citizenship results in a loss of $3119 over 5 years ($39,382 vs. $42,501) for the state and $4209 for society ($63,391 compared to $59,182) for adult women. Among adolescents, requiring proof of identity and citizenship results in a loss of $3123 for the state ($39,378 versus $42,501) and $4214 for society ($63,391 instead of $59,177).
  
  
  CONCLUSIONS
  Screening for citizenship status in publicly funded family planning clinics leads to financial losses for the state and society.
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA. rodriguezmar@who.int
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Rodriguez
authors.forename: Lisa
authors.initials: L
authors.lastname: Angus
authors.forename: Emily
authors.initials: E
authors.lastname: Elman
authors.forename: Philip D
authors.initials: PD
authors.lastname: Darney
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
mesh_terms: D000554:Ambulatory Care Facilities / Q000331:legislation & jurisprudence*; D003365:Costs and Cost Analysis; D004282:Documentation / Q000191:economics; D054242:Emigrants and Immigrants; D005193:Family Planning Services / Q000191:economics / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D008390:Markov Chains; D008484:Medicaid; D018803:Models, Economic; D009010:Monte Carlo Method; D009922:Oregon; D011247:Pregnancy; D049168:Pregnancy, Unplanned; D014481:United States