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Access to Reproductive Health Care for Women in Treatment for Substance Use Disorder

April 6, 2022

Women of reproductive age with substance use disorder (SUD) have lower rates of contraceptive use and higher rates of unintended pregnancy than women without SUD. Understanding the barriers to reproductive health care faced by these women is essential to meeting their health needs. We examined the reproductive health care access and needs of women in treatment for SUD using key informant interviews and focus groups conducted in Maryland and Ohio in 2019 and 2020. Study participants identified many unique reproductive health needs for women in treatment for SUD, including competing social and general health needs; histories of domestic violence, transactional sex, and sexual trauma; and the risks of experiencing an unplanned pregnancy during the sensitive treatment and recovery periods. Barriers to care may include stigma from health care providers, distrust of the health care system, and a perceived lack of autonomy over reproductive decisions. The siloed nature of the health care system, in which SUD treatment and recovery services are typically separated from other health care, was also identified as a major access barrier; study participants suggested co-locating reproductive health services in SUD treatment clinics to improve access to such care. They also emphasized the importance of delivering reproductive health care to women in treatment for SUD in supportive, noncoercive ways, and suggested offering culturally effective reproductive health care as part of women's overall health and well-being, rather than as a pregnancy prevention tool.

ACA Implementation Monitoring and Tracking Site Visit Report: Colorado

April 12, 2012

Assesses Colorado's progress in implementing federal healthcare reform legislation, including ongoing planning for the health insurance exchange, enrollment and subsidy determination, and Medicaid expansion, as well as work remaining on insurance reforms.

ACA Implementation Monitoring and Tracking: Maryland Site Visit Report

February 20, 2012

Assesses Maryland's progress in implementing the 2010 federal healthcare reform, including legislation to establish an insurance exchange, information technology development to facilitate enrollment and eligibility determinations, and insurance reforms.

A Long and Winding Road: Federally Qualified Health Centers, Community Variation and Prospects Under Reform

November 14, 2011

Outlines growth in the number of, demand, and federal funding for FQHCs between 1997 and 2009 in twelve communities and factors that shape FQHC development, including variations in Medicaid eligibility rules, employer-sponsored coverage, and demographics.

How Can California Policymakers Help Low-Income Children Benefit From National Health Reform?

June 30, 2011

Outlines healthcare reform provisions to expand coverage and access to care; factors that shape those gains; and state policies to maximize them, such as reforming eligibility determination systems, enabling telemedicine, and building safety-net capacity.

Covering Kids & Families: A Continuing Program for Increasing Insurance Coverage Among Low-Income Families

June 30, 2010

Explores the impact of the program's coalition-based approaches to improving Children's Health Insurance and Medicaid programs to increase enrollment on policy and procedures and assesses the outcomes of policy change on coverage of children and parents.

The Secrets of Massachusetts' Success: Why 97 Percent of State Residents Have Health Coverage

November 11, 2009

Analyzes the policies that helped expand coverage, including a data-driven eligibility system serving multiple programs, online applications via providers and community groups, and intensive public education. Considers national and state implications.

Growing Pains for the Los Angeles Healthy Kids Program: Findings From the Second Evaluation Case Study (Nov 2008)

November 7, 2008

Analyzes the initiative's continued efforts to provide health insurance for poor children ineligible for Medi-Cal or Healthy Families, as well as the challenges it faces, including the enrollment hold placed on 6- to 18-year-olds due to funding shortages.

Growing Pains for the Los Angeles Healthy Kids Program: Findings From the Second Evaluation Case Study (Apr 2008)

April 1, 2008

Evaluates the program to provide health coverage to poor children ineligible for Medi-Cal or Healthy Families in terms of outreach, enrollment, and retention; benefits, service delivery, and access; financing and stability; and program improvement.

Three Independent Evaluations of Healthy Kids Programs Find Dramatic Gains in Well-Being of Children and Families

November 1, 2007

Presents highlights from evaluations of a comprehensive health insurance coverage program for children, launched by Children's Health Initiatives and supported by the California Endowment, in Los Angeles, San Mateo, and Santa Clara counties.

Covering Kids & Families Case Study of Oregon: Exploring Medicaid and SCHIP Enrollment Trends and Their Links to Policy and Practice

August 31, 2007

Evaluates the impact in Oregon of the RWJF project to increase enrollment in Medicaid and State Children's Health Insurance Programs. Outlines state policy changes and local- and state-level findings on the links between activities and enrollment trends.

A Healthy Start for the Los Angeles Healthy Kids Program: Findings From the First Evaluation Site Visit

December 1, 2005

Analyzes the implementation and impact of the first two years of the Healthy Kids Program, and outlines key issues and challenges to achieving universal coverage and stable financing.